Difference between revisions of "Apasmara Nidana"

 
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|title=Apasmara Nidana
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|keywords=Apasmara, transient loss of memory, seizure disorders, epilepsy, mind-heart connection, mind-brain connection, Ayurveda, Indian system of medicine, charak samhita.
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|description=Nidana Sthana Chapter 8. Diagnosis and etiopathogenesis of seizure disorders
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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
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|image_alt=charak samhita
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|type=article
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}}
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<big>'''Nidana Sthana Chapter 8. Diagnosis and etiopathogenesis of seizure disorders'''</big>
 
{{Infobox
 
{{Infobox
 
|title = Apasmara Nidana
 
|title = Apasmara Nidana
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|label4 = Other Sections
 
|label4 = Other Sections
 
|data4 = [[Sutra Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
 
|data4 = [[Sutra Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
 +
|label6 = Translator and commentator
 +
|data6 = [[Yogesh Deole|Deole Y. S.]]
 +
|label7 = Reviewer
 +
|data7  = Khandel S.K
 +
|label8 = Editors
 +
|data8  = Khandel S.K, Godatwar P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
 +
|label9 = Year of publication
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|data9 =  2020
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|label10 = Publisher
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|data10 =  [[Charak Samhita Research, Training and Skill Development Centre]]
 +
|label11 = DOI
 +
|data11  = [https://doi.org/10.47468/CSNE.2020.e01.s02.009 10.47468/CSNE.2020.e01.s02.009]
 +
}}
  
|header3 =  
+
<big>'''Abstract'''</big>
 +
<p style='text-align:justify;'>This chapter deals with another psychiatric disorder leading to transient loss of consciousness termed as Apasmara. It describes causative factors, predisposing conditions, pathogenesis, signs, types, and prognosis of apasmara. The clinical presentation of this disease simulates the seizure disorders described in conventional medical literature. Apasmara is a common neuropsychiatric disorder characterized by intermittent loss of consciousness, memory, abnormal movements and blackouts. This chapter explores the basic principles of psychiatric disorders involving memory, mind, consciousness and intellect. These disorders are marked by major pathological obstacles in perception, impaired intellectual functioning, orientation, co-ordination and consciousness. Their management includes avoidance of etiological factors as well as pharmacological and non-pharmacological treatment (including psychological and spiritual therapies). The basic principles described in the present chapter can be helpful in preventing and managing neuro-psychiatric disorders like apasmara in a better way. This chapter also deals with some important aspects of diagnosis. It explains how one disease can trigger another disease i.e. Nidanarthakara roga, leading to the presence of two or more diseases at the same time. This chapter lays down some principles of diagnosis to manage such conditions as well. </p>
  
}}
+
'''Keywords''': apasmara, transient loss of memory, seizure disorders, epilepsy, mind-heart connection, mind-brain connection.
 +
</div>
  
==[[Nidana Sthana]] Chapter 8, Apasmara Nidana (Chapter on diagnosis of seizure disorders)==
 
 
=== Abstract ===
 
<div style="text-align:justify;">
 
The eighth chapter of [[Nidana Sthana]] describes causative factors, predisposing conditions, pathogenesis, signs, types, and prognosis of ''apasmara''. The clinical presentation of this disease simulates the seizure disorders described in modern medical literature. ''Apasmara'' is a common neuropsychiatric disorder characterized by intermittent loss of memory, abnormal movements and blackouts. This chapter explores the basic principles of psychiatric disorders involving memory, mind, consciousness and intellect. These disorders are marked by major pathological obstacles in perception, impaired intellectual functioning, orientation, co-ordination and consciousness. Their management includes avoidance of etiological factors  as well as pharmacological and non-pharmacological treatment  (including psychological and spiritual therapies). The basic principles described in the present chapter can be helpful in preventing and managing neuro-psychiatric disorders like ''apasmara'' in a better way. This chapter also deals with some important aspects of diagnosis. It explains how one disease can trigger another disease i.e. ''Nidanarthakara roga'', leading to the presence of two or more diseases at the same time. This chapter lays down some principles of diagnosis to manage such conditions as well.
 
  
'''Keywords''': ''Apasmara'', transient loss of memory, seizure disorders, epilepsy, mind-heart connection, mind-brain connection.
+
== Introduction ==
</div>
 
=== Introduction ===
 
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
In this important section dealing with the diagnoses of some common disorders of the body and the mind, the [[Nidana Sthana]], this eighth and concluding chapter deals with apasmara, a disorder afflicting the mind and sharing similar etiological and pathological factors as ''unmada'' (the subject of the preceding chapter). ''Apasmara'' (Sanskrit for ''apa'' (to lose) or leave, and ''smara'' (memory)) is a psychosomatic disorder involving memory, intellect and mind and present with cardinal features such as transient loss of memory, abnormal movements of body and blackouts. ''Apasmara'' is counted, in Ayurvedic texts, among the eight ''mahagada'' (most dreadful diseases). The extent of knowledge on the disease indicates that it must have been quite prevalent in antiquity. Ayurvedic scholars have observed that ''apasmara'' simulates epilepsy in its features<ref> Venkataraghvan S., Rajagopalan V, Srinivasan K. Study of doshik involvement in Apasmara (Epilepsy) and its utility. Ancient science of life, Vol.No.VI[3],1987.138-47  </ref> <ref> Murthy ARV, Singh RH.A Critical study on the Ayurvedic concept of the psychopathological basis of Apasmara. Journal of NIMA XXXII [6] 1990.7-11  </ref>. Epilepsy is a common neuropsychiatric condition involving mainly the brain, nervous system and the psyche. However, Ayurveda emphasizes heart, the abode of consciousness and mind, as its core pathological site while covering diseases of memory, intellect as well as psyche under the umbrella of ''apasmara''.  
+
In this important section dealing with the diagnoses of some common disorders of the body and the mind, this chapter deals with apasmara, a disorder afflicting the mind and sharing similar etiological and pathological factors as ''unmada'' (the subject of the preceding chapter). apasmara (Sanskrit for ''apa'' (to lose) or leave, and ''smara'' (memory)) is a psychosomatic disorder involving memory, intellect and mind and present with cardinal features such as transient loss of memory, abnormal movements of body and blackouts. apasmara is counted, in Ayurvedic texts, among the eight ''mahagada'' (most dreadful diseases). The extent of knowledge on the disease indicates that it must have been quite prevalent in antiquity. Ayurvedic scholars have observed that apasmara simulates epilepsy in its features<ref> Venkataraghvan S., Rajagopalan V, Srinivasan K. Study of doshik involvement in Apasmara (Epilepsy) and its utility. Ancient science of life, Vol.No.VI[3],1987.138-47  </ref> <ref> Murthy ARV, Singh RH.A Critical study on the Ayurvedic concept of the psychopathological basis of Apasmara. Journal of NIMA XXXII [6] 1990.7-11  </ref>. Epilepsy is a common neuropsychiatric condition involving mainly the brain, nervous system and the psyche. However, [[Ayurveda]] emphasizes heart, the abode of consciousness and mind, as its core pathological site while covering diseases of memory, intellect as well as psyche under the umbrella of apasmara.  
  
Causative factors of ''apasmara'' can be categorized under dietary, lifestyle, psychological and iatrogenic factors. Vitiated ''doshas'' get through the vessels of the heart and when exposed to predisposing psychological factors like excess worry, grief, anger, and fear, move upwards from the heart, the abode of all consciousness, to the brain, afflicting the senses while altering memory. This eventually leads to ''apasmara''. The etiology of the disease and specific features of the dominant ''doshas'' involved, and ''nidanarthakara roga'' (one disease causing other disease) and its importance in diagnosis and treatment have been described in detail in this chapter, with some important aspects of diagnosis addressed. In some cases, both diseases (the causative and the secondary ones) coexist while in other cases, the causative disease disappears and the new disease remains present. Thus, this chapter, while focusing on ''apasmara'', also talks of complications that lead to secondary conditions and their treatment.
+
Causative factors of apasmara can be categorized under dietary, lifestyle, psychological and iatrogenic factors. Vitiated ''[[dosha]]s'' get through the vessels of the heart and when exposed to predisposing psychological factors like excess worry, grief, anger, and fear, move upwards from the heart, the abode of all consciousness, to the brain, afflicting the senses while altering memory. This eventually leads to apasmara. The etiology of the disease and specific features of the dominant ''[[dosha]]s'' involved, and ''nidanarthakara roga'' (one disease causing other disease) and its importance in diagnosis and treatment have been described in detail in this chapter, with some important aspects of diagnosis addressed. In some cases, both diseases (the causative and the secondary ones) coexist while in other cases, the causative disease disappears and the new disease remains present. Thus, this chapter, while focusing on apasmara, also talks of complications that lead to secondary conditions and their treatment.
 
</div>
 
</div>
  
===Sanskrit Text, Transliteration and English Translation===
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==Sanskrit Text, Transliteration and English Translation==
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अथातोऽपस्मारनिदानं व्याख्यास्यामः ||१||  
 
अथातोऽपस्मारनिदानं व्याख्यास्यामः ||१||  
  
 
इति ह स्माह भगवानात्रेयः ||२||  
 
इति ह स्माह भगवानात्रेयः ||२||  
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athātō'pasmāranidānaṁ  vyākhyāsyāmaḥ||1||  
 
athātō'pasmāranidānaṁ  vyākhyāsyāmaḥ||1||  
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iti ha smAha bhagavAnAtreyaH||2||  
 
iti ha smAha bhagavAnAtreyaH||2||  
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</div></div>
  
“Now we shall discuss the diagnosis of ''Apasmara''”, said Lord Atreya [1-2]
+
Now we shall expound the chapter "Apasmara Nidana" (Diagnosis and etiopathogenesis of seizure disorders). Thus said Lord Atreya. [1-2]
  
==== Four types of ''apasmara'' ====
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=== Four types of apasmara ===
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<div class="mw-collapsible mw-collapsed">
  
 
इह खलु चत्वारोऽपस्मारा भवन्ति वातपित्तकफसन्निपातनिमित्ताः ||३||  
 
इह खलु चत्वारोऽपस्मारा भवन्ति वातपित्तकफसन्निपातनिमित्ताः ||३||  
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iha khalu catvārō'pasmārā bhavanti vātapittakaphasannipātanimittāḥ||3||  
 
iha khalu catvārō'pasmārā bhavanti vātapittakaphasannipātanimittāḥ||3||  
  
 
iha khalu catvAro~apasmArA bhavanti vAtapittakaphasannipAtanimittAH||3||
 
iha khalu catvAro~apasmArA bhavanti vAtapittakaphasannipAtanimittAH||3||
 +
</div></div>
  
There are four types of ''apasmara'' caused by ''vata, pitta, kapha'' and ''sannipatika'' (combination of all the three ''doshas'').[3]
+
There are four types of apasmara caused by ''[[vata]], [[pitta]], [[kapha]]'' and ''sannipatika'' (combination of all the three ''[[dosha]]s'').[3]
+
 
==== Persons prone to ''apasmara'' ====
+
=== Persons prone to apasmara ===
 +
<div class="mw-collapsible mw-collapsed">
  
 
त एवंविधानां प्राणभृतां क्षिप्रमभिनिर्वर्तन्ते; तद्यथा- रजस्तमोभ्यामुपहतचेतसामुद्भ्रान्तविषमबहुदोषाणां समलविकृतोपहितान्यशुचीन्यभ्यवहारजातानि वैषम्ययुक्तेनोपयोगविधिनोपयुञ्जानानां  
 
त एवंविधानां प्राणभृतां क्षिप्रमभिनिर्वर्तन्ते; तद्यथा- रजस्तमोभ्यामुपहतचेतसामुद्भ्रान्तविषमबहुदोषाणां समलविकृतोपहितान्यशुचीन्यभ्यवहारजातानि वैषम्ययुक्तेनोपयोगविधिनोपयुञ्जानानां  
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विषमाः समाचरतामत्युपक्षयाद्वा दोषाः प्रकुपिता:  रजस्तमोभ्यामुपहतचेतसामन्तरात्मनः  श्रेष्ठतममायतनं  हृदयमुपसृत्योपरि तिष्ठन्ते,  
 
विषमाः समाचरतामत्युपक्षयाद्वा दोषाः प्रकुपिता:  रजस्तमोभ्यामुपहतचेतसामन्तरात्मनः  श्रेष्ठतममायतनं  हृदयमुपसृत्योपरि तिष्ठन्ते,  
 
तथेन्द्रियायतनानि च | तत्र चावस्थिताः सन्तो यदा हृदयमिन्द्रियायतनानि चेरिताः कामक्रोधभयलोभमोहहर्षशोकचिन्तोद्वेगादिभिः सहसाऽभिपूरयन्ति, तदा जन्तुरपस्मरति ||४||
 
तथेन्द्रियायतनानि च | तत्र चावस्थिताः सन्तो यदा हृदयमिन्द्रियायतनानि चेरिताः कामक्रोधभयलोभमोहहर्षशोकचिन्तोद्वेगादिभिः सहसाऽभिपूरयन्ति, तदा जन्तुरपस्मरति ||४||
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ta ēvaṁvidhānāṁ prāṇabhr̥tāṁ kṣipramabhinirvartantē; tadyathā- Rajas tamōbhyāmupahatacētasāmudbhrāntaviṣamabahudōṣāṇāṁ  samalavikr̥tōpahitānyaśucīnyabhyavahārajātāni vaiṣamyayuktēnōpayōgavidhinōpayuñjānānāṁ tantraprayōgamapi  
 
ta ēvaṁvidhānāṁ prāṇabhr̥tāṁ kṣipramabhinirvartantē; tadyathā- Rajas tamōbhyāmupahatacētasāmudbhrāntaviṣamabahudōṣāṇāṁ  samalavikr̥tōpahitānyaśucīnyabhyavahārajātāni vaiṣamyayuktēnōpayōgavidhinōpayuñjānānāṁ tantraprayōgamapi  
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ca viShamamAcaratAmanyAshca sharIraceShTA viShamAHsamAcaratAmatyupakShayAdvA  doShAH prakupitA rajastamobhyAmupahatacetasAmantarAtmanaHshreShThatamamAyatanaM hRudayamupasRutyopari tiShThante, tathendriyAyatanAni ca|  
 
ca viShamamAcaratAmanyAshca sharIraceShTA viShamAHsamAcaratAmatyupakShayAdvA  doShAH prakupitA rajastamobhyAmupahatacetasAmantarAtmanaHshreShThatamamAyatanaM hRudayamupasRutyopari tiShThante, tathendriyAyatanAni ca|  
 
tatra cAvasthitAH santo yadA hRudayamindriyAyatanAni ceritAHkAmakrodhabhayalobhamohaharShashokacintodvegAdibhiH sahasA~abhipUrayanti, tadAjanturapasmarati||4||
 
tatra cAvasthitAH santo yadA hRudayamindriyAyatanAni ceritAHkAmakrodhabhayalobhamohaharShashokacintodvegAdibhiH sahasA~abhipUrayanti, tadAjanturapasmarati||4||
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</div></div>
  
Individuals get quickly afflicted with ''apasmara'' if:  
+
Individuals get quickly afflicted with apasmara if:  
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
*the mind of an individual is afflicted by ''rajas'' (mental ''dosha'' associated with hyperactivity) and ''tamas'' (mental ''dosha'' associated with hypoactivity);  
+
*the mind of an individual is afflicted by ''rajas'' (mental ''[[dosha]]'' associated with hyperactivity) and ''tamas'' (mental ''[[dosha]]'' associated with hypoactivity);  
*the three ''sharira doshas'' are imbalanced and excessively aggravated;  
+
*the three ''sharira [[dosha]]s'' are imbalanced and excessively aggravated;  
 
*an individual takes food that is impure, untimely, decomposed, possessing antagonistic properties, or touched/cooked by unclean hands  
 
*an individual takes food that is impure, untimely, decomposed, possessing antagonistic properties, or touched/cooked by unclean hands  
*an individual follows improper methods (of diet and lifestyle, conduct described in Ayurveda) and neglects prescribed rules;  
+
*an individual follows improper methods (of diet and lifestyle, conduct described in [[Ayurveda]]) and neglects prescribed rules;  
 
*an individual observes improper techniques (of treatment) and resorts to unhealthy regimen and behavior  
 
*an individual observes improper techniques (of treatment) and resorts to unhealthy regimen and behavior  
 
*an individual practices improper bodily movements and follows improper postures   
 
*an individual practices improper bodily movements and follows improper postures   
 
*an individual suffers from excessive degeneration or debility.  
 
*an individual suffers from excessive degeneration or debility.  
  
In the situations mentioned above, the ''doshas'' get aggravated and affect individuals whose minds are already afflicted by ''rajas'' and ''tamas''. The ''doshas'' (so aggravated) pervade the heart which is, as mentioned earlier, the abode of consciousness, as well as the sense organs. While there, the ''doshas'' get further aggravated by emotions such as passion, anger, fear, greed, attachment, excitement, grief, anxiety, perturbation etc., consequently spreading throughout the heart and the sense organs. The individual is then said to have been afflicted with ''apasmara''. [4]
+
In the situations mentioned above, the ''[[dosha]]s'' get aggravated and affect individuals whose minds are already afflicted by ''rajas'' and ''tamas''. The ''[[dosha]]s'' (so aggravated) pervade the heart which is, as mentioned earlier, the abode of consciousness, as well as the sense organs. While there, the ''[[dosha]]s'' get further aggravated by emotions such as passion, anger, fear, greed, attachment, excitement, grief, anxiety, perturbation etc., consequently spreading throughout the heart and the sense organs. The individual is then said to have been afflicted with apasmara. [4]
 
</div>
 
</div>
==== Characteristic features of ''apasmara'' ====
+
 
 +
=== Characteristic features of apasmara ===
 +
<div class="mw-collapsible mw-collapsed">
  
 
अपस्मारं पुनः स्मृतिबुद्धिसत्त्वसम्प्लवाद्बीभत्सचेष्टमावस्थिकं तमः प्रवेशमाचक्षते ||५||  
 
अपस्मारं पुनः स्मृतिबुद्धिसत्त्वसम्प्लवाद्बीभत्सचेष्टमावस्थिकं तमः प्रवेशमाचक्षते ||५||  
 +
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apasmāraṁ punaḥ smr̥ti buddhi sattva samplavādbībhatsacēṣṭamāvasthikaṁ  tamaḥ pravēśamācakṣatē||5||
 
apasmāraṁ punaḥ smr̥ti buddhi sattva samplavādbībhatsacēṣṭamāvasthikaṁ  tamaḥ pravēśamācakṣatē||5||
  
 
apasmAraM punaH smRutibuddhisattvasamplavAdbIbhatsaceShTamAvasthikaM tamaHpraveshamAcakShate||5||  
 
apasmAraM punaH smRutibuddhisattvasamplavAdbIbhatsaceShTamAvasthikaM tamaHpraveshamAcakShate||5||  
 +
</div></div>
  
''Apasmara'' is characterized by occasional loss of consciousness associated with aberrant activities (like vomiting of froth and abnormal postures of the body) and behavior, due to perversion of memory, intellect and other psychic faculties. [5]
+
apasmara is characterized by occasional loss of consciousness associated with aberrant activities (like vomiting of froth and abnormal postures of the body) and behavior, due to perversion of memory, intellect and other psychic faculties. [5]
 +
<div class="mw-collapsible mw-collapsed">
  
 
तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- भ्रूव्युदासः सततमक्ष्णोर्वैकृतमशब्दश्रवणंलालासिङ्घाणप्रस्रवणमनन्नाभिलषणमरोचकाविपाकौ हृदयग्रहः कुक्षेराटोपो दौर्बल्यमस्थिभेदोऽङ्गमर्दो मोहस्तमसो दर्शनंमूर्च्छा भ्रमश्चाभीक्ष्णं स्वप्ने च मदनर्तनव्यधनव्यथनवेपनपतनादीनीति ||६||  
 
तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- भ्रूव्युदासः सततमक्ष्णोर्वैकृतमशब्दश्रवणंलालासिङ्घाणप्रस्रवणमनन्नाभिलषणमरोचकाविपाकौ हृदयग्रहः कुक्षेराटोपो दौर्बल्यमस्थिभेदोऽङ्गमर्दो मोहस्तमसो दर्शनंमूर्च्छा भ्रमश्चाभीक्ष्णं स्वप्ने च मदनर्तनव्यधनव्यथनवेपनपतनादीनीति ||६||  
  
 
ततोऽनन्तरमपस्माराभिनिर्वृत्तिरेव ||७||  
 
ततोऽनन्तरमपस्माराभिनिर्वृत्तिरेव ||७||  
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tasyēmāni pūrvarūpāṇi bhavanti; tadyathā- bhrūvyudāsaḥ satatamakṣṇōrvaikr̥tamaśabdaśravaṇaṁ  
 
tasyēmāni pūrvarūpāṇi bhavanti; tadyathā- bhrūvyudāsaḥ satatamakṣṇōrvaikr̥tamaśabdaśravaṇaṁ  
 
lālāsiṅghāṇaprasravaṇamanannābhilaṣaṇamarōcakāvipākau hr̥dayagrahaḥ  
 
lālāsiṅghāṇaprasravaṇamanannābhilaṣaṇamarōcakāvipākau hr̥dayagrahaḥ  
 
kukṣērāṭōpō daurbalyamasthibhēdō'ṅgamardō mōhasTamasō darśanaṁ  
 
kukṣērāṭōpō daurbalyamasthibhēdō'ṅgamardō mōhasTamasō darśanaṁ  
mūrcchā bhramaścābhīkṣṇaṁ svapnē ca madanartanavyadhanavyathanavēpanapatanādīnīti||6||   
+
mūrcchā bhramaścābhīkṣṇaṁ svapnē ca madanartanavyadhanavyathanavēpanapatanādīnīti||6||   
  
 
tatō'nantaramapasmārābhinirvr̥ttirēva||7||
 
tatō'nantaramapasmārābhinirvr̥ttirēva||7||
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tato~anantaramapasmArAbhinirvRuttireva||7||  
 
tato~anantaramapasmArAbhinirvRuttireva||7||  
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<div style="text-align:justify;">
 
<div style="text-align:justify;">
Premonitory symptoms of ''apasmara'' include contraction of eyebrows, erratic and constant movement of eyes, auditory hallucinations, excessive salivation, and nasal discharge. There is frequent accompaniment of anorexia, indigestion, and general disinclination towards food, chest congestion, distension of the lower abdomen accompanied with gurgling sound, weakness, cracking pain in bones and malaise, unconsciousness, a feeling of despondency or depression, fainting and giddiness, and frequent dreams of scenes of intoxication, dancing, murdering, aching, shivering and falling. [6]
+
Premonitory symptoms of apasmara include contraction of eyebrows, erratic and constant movement of eyes, auditory hallucinations, excessive salivation, and nasal discharge. There is frequent accompaniment of anorexia, indigestion, and general disinclination towards food, chest congestion, distension of the lower abdomen accompanied with gurgling sound, weakness, cracking pain in bones and malaise, unconsciousness, a feeling of despondency or depression, fainting and giddiness, and frequent dreams of scenes of intoxication, dancing, murdering, aching, shivering and falling. [6]
 
</div>
 
</div>
These are some common premonitory symptoms of ''apasmara''. [7]
+
These are some common premonitory symptoms of apasmara. [7]
 +
 
 +
=== Specific types and features of apasmara ===
  
==== Specific types and features of ''apasmara'' ====
+
==== ''Vata dosha'' dominant apasmara ====
 +
<div class="mw-collapsible mw-collapsed">
  
===== ''Vata dosha'' dominant ''apasmara'' =====
+
तत्रेदमपस्मारविशेषविज्ञानं भवति; तद्यथा-
  
तत्रेदमपस्मारविशेषविज्ञानं भवति; तद्यथा- अभीक्ष्णमपस्मरन्तं, क्षणेन  सञ्ज्ञां प्रतिलभमानम्, उत्पिण्डिताक्षम्, असाम्नाविलपन्तम्,  
+
अभीक्ष्णमपस्मरन्तं, क्षणेन  सञ्ज्ञां प्रतिलभमानम्, उत्पिण्डिताक्षम्, असाम्नाविलपन्तम्,  
 
उद्वमन्तं फेनम्, अतीवाध्मातग्रीवम्, आविद्धशिरस्कं, विषमविनताङ्गुलिम्, अनवस्थितपाणिपादम्, अरुणपरुषश्यावनखनयनवदनत्वचम्, अनवस्थितचपलपरुषरूक्षरूपदर्शिनं, वातलानुपशयं, विपरीतोपशयं च वातेनापस्मरन्तं विद्यात् ||८||
 
उद्वमन्तं फेनम्, अतीवाध्मातग्रीवम्, आविद्धशिरस्कं, विषमविनताङ्गुलिम्, अनवस्थितपाणिपादम्, अरुणपरुषश्यावनखनयनवदनत्वचम्, अनवस्थितचपलपरुषरूक्षरूपदर्शिनं, वातलानुपशयं, विपरीतोपशयं च वातेनापस्मरन्तं विद्यात् ||८||
 +
<div class="mw-collapsible-content">
  
 
tatrēdamapasmāraviśēṣavijñānaṁ bhavati;  
 
tatrēdamapasmāraviśēṣavijñānaṁ bhavati;  
tadyathā- abhīkṣṇamApasmarantaṁ, kṣaṇēna  
+
tadyathā-  
 +
 
 +
abhīkṣṇamApasmarantaṁ, kṣaṇēna  
 
sañjñāṁ pratilabhamānam, utpiṇḍitākṣam, asāmnā vilapantam, udvamantaṁ phēnam, atīvādhmātagrīvam, āviddhaśiraskaṁ, viṣamavinatāṅgulim, anavasthitapāṇipādam,  aruṇaparuṣaśyāvanakhanayanavadanatvacam,  
 
sañjñāṁ pratilabhamānam, utpiṇḍitākṣam, asāmnā vilapantam, udvamantaṁ phēnam, atīvādhmātagrīvam, āviddhaśiraskaṁ, viṣamavinatāṅgulim, anavasthitapāṇipādam,  aruṇaparuṣaśyāvanakhanayanavadanatvacam,  
 
anavasthitacapalaparuṣarūkṣarūpadarśinaṁ, vātalānupaśayaṁ,  
 
anavasthitacapalaparuṣarūkṣarūpadarśinaṁ, vātalānupaśayaṁ,  
 
viparītōpaśayaṁ ca vātēnāpasmarantaṁ  
 
viparītōpaśayaṁ ca vātēnāpasmarantaṁ  
vidyāt  (1)||8||
+
vidyāt (1)||8||
 +
 
 +
tatredamapasmAravisheShavij~jAnaM bhavati; tadyathA-
 +
 
 +
abhIkShNamapasmarantaM, kShaNena sa~jj~jAM pratilabhamAnam, utpiNDitAkSham, asAmnA vilapantam, udvamantaM phenam,atIvAdhmAtagrIvam, AviddhashiraskaM, viShamavinatA~ggulim, anavasthitapANipAdam,aruNaparuShashyAvanakhanayanavadanatvacam, anavasthitacapalaparuSharUkSharUpadarshinaM,vAtalAnupashayaM, viparItopashayaM ca vAtenApasmarantaM vidyAt (1)||8||
 +
</div></div>
  
tatredamapasmAravisheShavij~jAnaM bhavati; tadyathA- abhIkShNamapasmarantaM, kShaNena sa~jj~jAM pratilabhamAnam, utpiNDitAkSham, asAmnA vilapantam, udvamantaM phenam,atIvAdhmAtagrIvam, AviddhashiraskaM, viShamavinatA~ggulim, anavasthitapANipAdam,aruNaparuShashyAvanakhanayanavadanatvacam, anavasthitacapalaparuSharUkSharUpadarshinaM,vAtalAnupashayaM, viparItopashayaM ca vAtenApasmarantaM  vidyAt (1)||8|| 
 
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
More frequent episodes of ''apasmara'', episodes of instant loss of consciousness and regain it quickly, bulging or rolling up of eyes, incoherent speech, frothy vomit, excessive stiffness of neck, drooping of the head to one side, irregular contraction of fingers, unstable upper and lower limbs, redness, dryness and grayish tint in the nails, eyes, face and skin, apparent vision or perception of unstable, fickle, coarse and dry objects, conditions associated with consuming ''vata''-aggravating diets and alleviation of ailments when subjected to ''vata''-pacifying diets.[8-1]
+
More frequent episodes of apasmara, episodes of instant loss of consciousness and regain it quickly, bulging or rolling up of eyes, incoherent speech, frothy vomit, excessive stiffness of neck, drooping of the head to one side, irregular contraction of fingers, unstable upper and lower limbs, redness, dryness and grayish tint in the nails, eyes, face and skin, apparent vision or perception of unstable, fickle, coarse and dry objects, conditions associated with consuming ''[[vata]]''-aggravating diets and alleviation of ailments when subjected to ''[[vata]]''-pacifying diets.[8-1]
 
</div>
 
</div>
===== ''Pitta''-dominant ''apasmara'' =====
+
 
 +
==== ''[[Pitta]]''-dominant apasmara ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
अभीक्ष्णमपस्मरन्तं क्षणेन  सञ्ज्ञां प्रतिलभमानम्, अवकूजन्तम्, आस्फालयन्तं भूमिं, हरितहारिद्रताम्रनखनयनवदनत्वचं,रुधिरोक्षितोग्रभैरवादीप्तरुषितरूपदर्शिनं, पित्तलानुपशयं,विपरीतोपशयं च पित्तेनापस्मरन्तं विद्यात् ||८||  
 
अभीक्ष्णमपस्मरन्तं क्षणेन  सञ्ज्ञां प्रतिलभमानम्, अवकूजन्तम्, आस्फालयन्तं भूमिं, हरितहारिद्रताम्रनखनयनवदनत्वचं,रुधिरोक्षितोग्रभैरवादीप्तरुषितरूपदर्शिनं, पित्तलानुपशयं,विपरीतोपशयं च पित्तेनापस्मरन्तं विद्यात् ||८||  
 +
<div class="mw-collapsible-content">
 +
 
abhīkṣṇamapasmarantaṁ kṣaṇēna sañjñāṁ pratilabhamānam, avakūjantam, āsphālayantaṁ bhūmiṁ, haritahāridratāmranakhanayanavadanatvacaṁ, rudhirōkṣitōgrabhairavādīptaruṣitarūpadarśinaṁ, pittalānupaśayaṁ,viparītōpaśayaṁ ca pittēnāpasmarantaṁ vidyāt (2)||8||
 
abhīkṣṇamapasmarantaṁ kṣaṇēna sañjñāṁ pratilabhamānam, avakūjantam, āsphālayantaṁ bhūmiṁ, haritahāridratāmranakhanayanavadanatvacaṁ, rudhirōkṣitōgrabhairavādīptaruṣitarūpadarśinaṁ, pittalānupaśayaṁ,viparītōpaśayaṁ ca pittēnāpasmarantaṁ vidyāt (2)||8||
  
 
abhIkShNamapasmarantaM kShaNena sa~jj~jAM pratilabhamAnam, avakUjantam, AsphAlayantaMbhUmiM, haritahAridratAmranakhanayanavadanatvacaM,rudhirokShitograbhairavAdIptaruShitarUpadarshinaM, pittalAnupashayaM,viparItopashayaM capittenApasmarantaM vidyAt (2)||8||  
 
abhIkShNamapasmarantaM kShaNena sa~jj~jAM pratilabhamAnam, avakUjantam, AsphAlayantaMbhUmiM, haritahAridratAmranakhanayanavadanatvacaM,rudhirokShitograbhairavAdIptaruShitarUpadarshinaM, pittalAnupashayaM,viparItopashayaM capittenApasmarantaM vidyAt (2)||8||  
 +
</div></div>
 +
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
Frequent episodes of ''apasmara'', instant loss of consciousness and regaining it quickly, stertorous breathing, abnormal, dragging-like movement, green, yellow or coppery tint of nails, eyes, face and skin, apparent vision or perception of bleeding, terrifying, horrible, burning and angry looking objects, conditions associated with ''pitta''-aggravating diets and alleviation of ailments when subjected to ''pitta''-pacifying diets [8-2]
+
Frequent episodes of apasmara, instant loss of consciousness and regaining it quickly, stertorous breathing, abnormal, dragging-like movement, green, yellow or coppery tint of nails, eyes, face and skin, apparent vision or perception of bleeding, terrifying, horrible, burning and angry looking objects, conditions associated with ''[[pitta]]''-aggravating diets and alleviation of ailments when subjected to ''[[pitta]]''-pacifying diets [8-2]
 
</div>
 
</div>
===== ''Kapha''-dominant ''apasmara'' =====
+
 
 +
==== ''[[Kapha]]''-dominant apasmara ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
चिरादपस्मरन्तं, चिराच्च सञ्ज्ञां प्रतिलभमानं, पतन्तम्, अनतिविकृतचेष्टं, लालामुद्वमन्तं, शुक्लनखनयनवदनत्वचं,शुक्लगुरुस्निग्धरूपदर्शिनं, श्लेष्मलानुपशयं, विपरीतोपशयं च श्लेष्मणाऽपस्मर-न्तं विद्यात् ||८||  
 
चिरादपस्मरन्तं, चिराच्च सञ्ज्ञां प्रतिलभमानं, पतन्तम्, अनतिविकृतचेष्टं, लालामुद्वमन्तं, शुक्लनखनयनवदनत्वचं,शुक्लगुरुस्निग्धरूपदर्शिनं, श्लेष्मलानुपशयं, विपरीतोपशयं च श्लेष्मणाऽपस्मर-न्तं विद्यात् ||८||  
 +
<div class="mw-collapsible-content">
  
 
cirādapasmarantaṁ, cirācca sañjñāṁ pratilabhamānaṁ, patantam, anativikr̥tacēṣṭaṁ, lālāmudvamantaṁ, śuklanakhanayanavadanatvacaṁ, śuklagurusnigdharūpadarśinaṁ, ślēṣmalānupaśayaṁ, viparītōpaśayaṁ ca ślēṣmaṇā'pasmarantaṁ vidyāt  (3)||8||
 
cirādapasmarantaṁ, cirācca sañjñāṁ pratilabhamānaṁ, patantam, anativikr̥tacēṣṭaṁ, lālāmudvamantaṁ, śuklanakhanayanavadanatvacaṁ, śuklagurusnigdharūpadarśinaṁ, ślēṣmalānupaśayaṁ, viparītōpaśayaṁ ca ślēṣmaṇā'pasmarantaṁ vidyāt  (3)||8||
  
 
cirAdapasmarantaM, cirAcca sa~jj~jAM pratilabhamAnaM, patantam, anativikRutaceShTaM,lAlAmudvamantaM, shuklanakhanayanavadanatvacaM, shuklagurusnigdharUpadarshinaM,shleShmalAnupashayaM, viparItopashayaM ca shleShmaNA~apasmarantaM vidyAt (3)||8||  
 
cirAdapasmarantaM, cirAcca sa~jj~jAM pratilabhamAnaM, patantam, anativikRutaceShTaM,lAlAmudvamantaM, shuklanakhanayanavadanatvacaM, shuklagurusnigdharUpadarshinaM,shleShmalAnupashayaM, viparItopashayaM ca shleShmaNA~apasmarantaM vidyAt (3)||8||  
 +
</div></div>
 +
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
Less frequent episodes of ''apasmara'', gradual loss and regain of consciousness, frequently falling down, less pronounced abnormalities in movement, dribbling of saliva, whitish discoloration of nails, eyes, face, and skin, apparent vision or perception of white, heavy and unctuous objects, and conditions associated with consuming ''kapha''-aggravating diets and alleviation of ailments when subjected to ''kapha''-pacifying diets [8-3]
+
Less frequent episodes of apasmara, gradual loss and regain of consciousness, frequently falling down, less pronounced abnormalities in movement, dribbling of saliva, whitish discoloration of nails, eyes, face, and skin, apparent vision or perception of white, heavy and unctuous objects, and conditions associated with consuming ''[[kapha]]''-aggravating diets and alleviation of ailments when subjected to ''[[kapha]]''-pacifying diets [8-3]
 
</div>
 
</div>
===== ''Sannipatika apasmara'' with dominance of all ''dosha'' =====
+
 
 +
==== ''Sannipatika apasmara'' with dominance of all ''[[dosha]]'' ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
समवेतसर्वलिङ्गमपस्मारं सान्निपातिकं विद्यात्, तमसाध्यमाचक्षते
 
समवेतसर्वलिङ्गमपस्मारं सान्निपातिकं विद्यात्, तमसाध्यमाचक्षते
 
इति चत्वारोऽपस्मारा व्याख्याताः ||८||  
 
इति चत्वारोऽपस्मारा व्याख्याताः ||८||  
 +
<div class="mw-collapsible-content">
  
 
samavētasarvaliṅgamapasmāraṁ sānnipātikaṁ vidyāt, Tamasādhyamācakṣatē ||  
 
samavētasarvaliṅgamapasmāraṁ sānnipātikaṁ vidyāt, Tamasādhyamācakṣatē ||  
Line 161: Line 222:
  
 
iti catvAro~apasmArA vyAkhyAtAH||8||  
 
iti catvAro~apasmArA vyAkhyAtAH||8||  
 +
</div></div>
  
''Sannipatika apasmara'' (caused by the simultaneous vitiation of all the three ''doshas'') shares the symptoms of all the three ''doshas'' (described above). This condition is incurable.  
+
''Sannipatika apasmara'' (caused by the simultaneous vitiation of all the three ''[[dosha]]s'') shares the symptoms of all the three ''[[dosha]]s'' (described above). This condition is incurable.  
  
Thus, four types of ''apasmara'' are explained. [8-4]
+
Thus, four types of apasmara are explained. [8-4]
  
===== ''Apasmara'' with extrinsic factors =====
+
==== apasmara with extrinsic factors ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
तेषामागन्तुरनुबन्धो भवत्येव कदाचित्, तमुत्तरकालमुपदेक्ष्यामः |  
 
तेषामागन्तुरनुबन्धो भवत्येव कदाचित्, तमुत्तरकालमुपदेक्ष्यामः |  
 +
 
तस्य विशेषविज्ञानं यथोक्तलिङ्गैर्लिङ्गाधिक्यमदोषलिङ्गानुरूपं च किञ्चित् ||९||  
 
तस्य विशेषविज्ञानं यथोक्तलिङ्गैर्लिङ्गाधिक्यमदोषलिङ्गानुरूपं च किञ्चित् ||९||  
 +
<div class="mw-collapsible-content">
 +
 +
tēṣāmāganturanubandhō bhavatyēva kadācit, tamuttarakālamupadēkṣyāmaḥ|
  
tēṣāmāganturanubandhō bhavatyēva kadācit, tamuttarakālamupadēkṣyāmaḥ| tasya viśēṣavijñānaṁ yathōktaliṅgairliṅgādhikyamadōṣaliṅgānurūpaṁ ca kiñcit||9||
+
tasya viśēṣavijñānaṁ yathōktaliṅgairliṅgādhikyamadōṣaliṅgānurūpaṁ ca kiñcit||9||
  
 
teShAmAganturanubandho bhavatyeva kadAcit, tamuttarakAlamupadekShyAmaH|  
 
teShAmAganturanubandho bhavatyeva kadAcit, tamuttarakAlamupadekShyAmaH|  
 +
 
tasya visheShavij~jAnaM yathoktali~ggairli~ggAdhikyamadoShali~ggAnurUpaM ca ki~jcit||9||
 
tasya visheShavij~jAnaM yathoktali~ggairli~ggAdhikyamadoShali~ggAnurUpaM ca ki~jcit||9||
 +
</div></div>
  
 
Sometimes these conditions are associated with extrinsic causative factors described later (in Cikitsa10:53). The symptoms that manifest in such cases, though, are not the same as those caused by vitiated ''doshas''. [9]
 
Sometimes these conditions are associated with extrinsic causative factors described later (in Cikitsa10:53). The symptoms that manifest in such cases, though, are not the same as those caused by vitiated ''doshas''. [9]
  
==== Management of ''apasmara'' ====
+
=== Management of apasmara ===
 +
<div class="mw-collapsible mw-collapsed">
  
 
हितान्यपस्मारिभ्यस्तीक्ष्णानि संशोधनान्युपशमनानि च यथास्वं, मन्त्रादीनि चागन्तुसंयोगे ||१०||  
 
हितान्यपस्मारिभ्यस्तीक्ष्णानि संशोधनान्युपशमनानि च यथास्वं, मन्त्रादीनि चागन्तुसंयोगे ||१०||  
 +
<div class="mw-collapsible-content">
 +
 
hitānyapasmāribhyastīkṣṇāni saṁśōdhanānyupaśamanāni ca yathāsvaṁ, mantrādīni cāgantusaṁyōgē||10||
 
hitānyapasmāribhyastīkṣṇāni saṁśōdhanānyupaśamanāni ca yathāsvaṁ, mantrādīni cāgantusaṁyōgē||10||
  
 
hitAnyapasmAribhyastIkShNAni saMshodhanAnyupashamanAni ca yathAsvaM, mantrAdInicAgantusaMyoge||10||
 
hitAnyapasmAribhyastIkShNAni saMshodhanAnyupashamanAni ca yathAsvaM, mantrAdInicAgantusaMyoge||10||
 +
</div></div>
  
Strong elimination and alleviation therapies are effective in alleviating and curing ''apasmara''. When extrinsic causative factors are involved, then ''mantras'' etc., are considered useful. [10]
+
Strong elimination and alleviation therapies are effective in alleviating and curing apasmara. When extrinsic causative factors are involved, then ''mantras'' etc., are considered useful. [10]
  
==== Manifestation of various diseases ====
+
=== Manifestation of various diseases ===
 +
<div class="mw-collapsible mw-collapsed">
  
 
तस्मिन् हि दक्षाध्वरध्वंसे देहिनां नानादिक्षु विद्रवतामभिद्रवणतरणधावनप्लवनलङ्घनाद्यैर्देहविक्षोभणैः पुरागुल्मोत्पत्तिरभूत्, हविष्प्राशात् प्रमेहकुष्ठानां, भयत्रासशोकैरुन्मादानां,  
 
तस्मिन् हि दक्षाध्वरध्वंसे देहिनां नानादिक्षु विद्रवतामभिद्रवणतरणधावनप्लवनलङ्घनाद्यैर्देहविक्षोभणैः पुरागुल्मोत्पत्तिरभूत्, हविष्प्राशात् प्रमेहकुष्ठानां, भयत्रासशोकैरुन्मादानां,  
 
विविधभूताशुचिसंस्पर्शादपस्माराणां, ज्वरस्तु खलुमहेश्वरललाटप्रभवः  ,  
 
विविधभूताशुचिसंस्पर्शादपस्माराणां, ज्वरस्तु खलुमहेश्वरललाटप्रभवः  ,  
 
तत्सन्तापाद्रक्तपित्तम्, अतिव्यवायात् पुनर्नक्षत्रराजस्य राजयक्ष्मेति ||११||  
 
तत्सन्तापाद्रक्तपित्तम्, अतिव्यवायात् पुनर्नक्षत्रराजस्य राजयक्ष्मेति ||११||  
 +
<div class="mw-collapsible-content">
 +
 
tasmin  hi dakṣādhvaradhvaṁsē  dēhināṁ  nānādikṣu  
 
tasmin  hi dakṣādhvaradhvaṁsē  dēhināṁ  nānādikṣu  
 
vidravatāmabhidravaṇataraṇadhāvanaplavanalaṅghanādyairdēhavikṣōbhaṇaiḥ purā gulmōtpattirabhūt, haviṣprāśāt pramēhakuṣṭhānāṁ,  
 
vidravatāmabhidravaṇataraṇadhāvanaplavanalaṅghanādyairdēhavikṣōbhaṇaiḥ purā gulmōtpattirabhūt, haviṣprāśāt pramēhakuṣṭhānāṁ,  
Line 199: Line 275:
  
 
tasmin hi dakShAdhvaradhvaMse dehinAM nAnAdikShuvidravatAmabhidravaNataraNadhAvanaplavanala~gghanAdyairdehavikShobhaNaiH purAgulmotpattirabhUt, haviShprAshAt pramehakuShThAnAM, bhayatrAsashokairunmAdAnAM,vividhabhUtAshucisaMsparshAdapasmArANAM, jvarastu khalu maheshvaralalATaprabhavaH ,tatsantApAdraktapittam, ativyavAyAt punarnakShatrarAjasya rAjayakShmeti||11||  
 
tasmin hi dakShAdhvaradhvaMse dehinAM nAnAdikShuvidravatAmabhidravaNataraNadhAvanaplavanala~gghanAdyairdehavikShobhaNaiH purAgulmotpattirabhUt, haviShprAshAt pramehakuShThAnAM, bhayatrAsashokairunmAdAnAM,vividhabhUtAshucisaMsparshAdapasmArANAM, jvarastu khalu maheshvaralalATaprabhavaH ,tatsantApAdraktapittam, ativyavAyAt punarnakShatrarAjasya rAjayakShmeti||11||  
 +
</div></div>
 +
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
As per vedic legends, in the aftermath of destruction of Daksha’s ''yajna'' (holy sacrifice), ''gulma'' (disease similar to lumps in abdomen) was manifested first in human beings due to stress induced as a result of fleeing, swimming, running, flying, etc. in all directions. ''Prameha'' (disease of obstinate urinary disorders) and ''kushtha'' (obstinate skin diseases including leprosy) were manifested due to excess intake of ghee. Various types of ''unmada'' (insanity/psychosis) were manifested due to fear, apprehension and grief. ''Apasmara'' (epilepsy) set in due to coming in contact with various types of unclean objects. ''Jwara'' came out of the forehead of Lord Shiva, and ''raktapitta'' was manifested (a condition characterized by bleeding from different parts of the body) due to ''jwara''’s heat. Moon was afflicted with ''rajayakshma'' due to excessive sexual indulgence. [11]
+
As per vedic legends, in the aftermath of destruction of Daksha’s ''yajna'' (holy sacrifice), ''gulma'' (disease similar to lumps in abdomen) was manifested first in human beings due to stress induced as a result of fleeing, swimming, running, flying, etc. in all directions. ''Prameha'' (disease of obstinate urinary disorders) and ''kushtha'' (obstinate skin diseases including leprosy) were manifested due to excess intake of ghee. Various types of ''unmada'' (insanity/psychosis) were manifested due to fear, apprehension and grief. apasmara (epilepsy) set in due to coming in contact with various types of unclean objects. ''[[Jwara']]' came out of the forehead of Lord Shiva, and ''raktapitta'' was manifested (a condition characterized by bleeding from different parts of the body) due to ''[[jwara]]''’s heat. Moon was afflicted with ''rajayakshma'' due to excessive sexual indulgence. [11]
 
</div>
 
</div>
==== Summary ====
 
  
भवन्ति चात्र- अपस्मारो हि वातेन पित्तेन च कफेन च |  
+
=== Summary ===
 +
<div class="mw-collapsible mw-collapsed">
 +
 
 +
भवन्ति चात्र-  
 +
 
 +
अपस्मारो हि वातेन पित्तेन च कफेन च |  
 +
 
 
चतुर्थः सन्निपातेन प्रत्याख्येयस्तथाविधः ||१२||  
 
चतुर्थः सन्निपातेन प्रत्याख्येयस्तथाविधः ||१२||  
  
 
साध्यांस्तु भिषजः प्राज्ञाः साधयन्ति समाहिताः |  
 
साध्यांस्तु भिषजः प्राज्ञाः साधयन्ति समाहिताः |  
 +
 
तीक्ष्णैः संशोधनैश्चैव यथास्वं शमनैरपि ||१३||  
 
तीक्ष्णैः संशोधनैश्चैव यथास्वं शमनैरपि ||१३||  
  
 
यदा दोषनिमित्तस्य भवत्यागन्तुरन्वयः |  
 
यदा दोषनिमित्तस्य भवत्यागन्तुरन्वयः |  
 +
 
तदा साधारणं कर्म प्रवदन्ति भिषग्विदः ||१४||
 
तदा साधारणं कर्म प्रवदन्ति भिषग्विदः ||१४||
 +
<div class="mw-collapsible-content">
  
bhavanti cātra-  
+
bhavanti cātra-  
apasmārō hi vātēna pittēna ca kaphēna ca| caturthaḥ sannipātēna
 
pratyākhyēyastathāvidhaḥ||12||
 
  
sādhyāṁstu bhiṣajaḥ prājñāḥ sādhayanti samāhitāḥ| tīkṣṇaiḥ
+
apasmārō hi vātēna pittēna ca kaphēna ca|  
saṁśōdhanaiścaiva yathāsvaṁ śamanairapi||13||  
 
  
yadā dōṣanimittasya bhavatyāganturanvayaḥ| tadā sādhāraṇaṁ karma pravadanti bhiṣagvidaḥ||14||
+
caturthaḥ sannipātēna pratyākhyēyastathāvidhaḥ||12||
 +
 
 +
sādhyāṁstu bhiṣajaḥ prājñāḥ sādhayanti samāhitāḥ|
 +
 
 +
tīkṣṇaiḥ saṁśōdhanaiścaiva yathāsvaṁ śamanairapi||13||
 +
 
 +
yadā dōṣanimittasya bhavatyāganturanvayaḥ|  
 +
 
 +
tadā sādhāraṇaṁ karma pravadanti bhiṣagvidaḥ||14||
  
 
bhavanti cAtra- apasmAro hi vAtena pittena ca kaphena ca|  
 
bhavanti cAtra- apasmAro hi vAtena pittena ca kaphena ca|  
 +
 
caturthaH sannipAtena pratyAkhyeyastathAvidhaH||12||  
 
caturthaH sannipAtena pratyAkhyeyastathAvidhaH||12||  
  
 
sAdhyAMstu bhiShajaH prAj~jAH sAdhayanti samAhitAH|  
 
sAdhyAMstu bhiShajaH prAj~jAH sAdhayanti samAhitAH|  
 +
 
tIkShNaiH saMshodhanaishcaiva yathAsvaM shamanairapi||13||  
 
tIkShNaiH saMshodhanaishcaiva yathAsvaM shamanairapi||13||  
  
 
yadA doShanimittasya bhavatyAganturanvayaH|  
 
yadA doShanimittasya bhavatyAganturanvayaH|  
 +
 
tadA sAdhAraNaM karma pravadanti bhiShagvidaH||14||
 
tadA sAdhAraNaM karma pravadanti bhiShagvidaH||14||
 +
</div></div>
 +
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
From the preceding verses, it can be said that ''apasmara'' manifests itself due to the vitiation of ''vata, pitta'' and ''kapha'' and ''sannipata'' (combined vitiation of all the three ''doshas''). The ''sannipata'' variation is incurable. [12]
+
From the preceding verses, it can be said that apasmara manifests itself due to the vitiation of ''[[vata]], [[pitta]]'' and ''[[kapha]]'' and ''sannipata'' (combined vitiation of all the three ''[[dosha]]s''). The ''sannipata'' variation is incurable. [12]
  
The curable types of ''apasmara'' should be carefully treated by a physician possessing extensive knowledge and experience of administering elimination and alleviation therapies associated with the ''dosha''(s) causing the specific variant of ''apasmara''. [13]
+
The curable types of apasmara should be carefully treated by a physician possessing extensive knowledge and experience of administering elimination and alleviation therapies associated with the ''[[dosha]]''(s) causing the specific variant of apasmara. [13]
  
When ''apasmara'' is caused by the vitiation of ''doshas'' associated with extrinsic causative factors, then general therapies addressing both (''doshic'' equilibrium and extrinsic causes) are advised by the best of physicians.  [14]
+
When apasmara is caused by the vitiation of ''[[dosha]]s'' associated with extrinsic causative factors, then general therapies addressing both (''doshic'' equilibrium and extrinsic causes) are advised by the best of physicians.  [14]
 
</div>
 
</div>
सर्वरोगविशेषज्ञः सर्वौषधविशारदः| भिषक् सर्वामयान् हन्ति न च मोहं निगच्छति ||१५||
+
<div class="mw-collapsible mw-collapsed">
 +
 
 +
सर्वरोगविशेषज्ञः सर्वौषधविशारदः|  
 +
 
 +
भिषक् सर्वामयान् हन्ति न च मोहं निगच्छति ||१५||
 +
<div class="mw-collapsible-content">
  
sarvarōgaviśēṣajñaḥ sarvauṣadhaviśāradaḥ| bhiṣak sarvāmayān  
+
sarvarōgaviśēṣajñaḥ sarvauṣadhaviśāradaḥ|  
hanti na ca mōhaṁ nigacchati ||15||
+
 
 +
bhiṣak sarvāmayān hanti na ca mōhaṁ nigacchati ||15||
  
 
sarvarogavisheShaj~jaH sarvauShadhavishAradaH|  
 
sarvarogavisheShaj~jaH sarvauShadhavishAradaH|  
 +
 
bhiShak sarvAmayAn hanti na ca mohaM nigacchati ||15||  
 
bhiShak sarvAmayAn hanti na ca mohaM nigacchati ||15||  
 +
</div></div>
  
 
An able physician, well versed in the specific characteristics of all diseases and the properties of all medicines, cures all (curable) diseases and does not get confused. [15]
 
An able physician, well versed in the specific characteristics of all diseases and the properties of all medicines, cures all (curable) diseases and does not get confused. [15]
 +
<div class="mw-collapsible mw-collapsed">
  
 
इत्येतदखिलेनोक्तं निदानस्थानमुत्तमम् |१६|  
 
इत्येतदखिलेनोक्तं निदानस्थानमुत्तमम् |१६|  
 +
<div class="mw-collapsible-content">
  
 
ityētadakhilēnōktaṁ nidānasthānamuttamam|16|
 
ityētadakhilēnōktaṁ nidānasthānamuttamam|16|
  
 
ityetadakhilenoktaM nidAnasthAnamuttamam|16|
 
ityetadakhilenoktaM nidAnasthAnamuttamam|16|
 +
</div></div>
  
This concludes the (excellent section titled) [[Nidana Sthana]]. [16]  
+
This concludes the (excellent section titled) [[Nidana Sthana]]. [16]
  
==== Diagnostic principles of diseases ====
+
=== Diagnostic principles of diseases ===
  
===== ''Nidanarthakara roga'' (disease specific causes) =====
+
==== ''Nidanarthakara roga'' (disease specific causes) ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
निदानार्थकरो रोगो रोगस्याप्युपलभ्यते ||१६||  
 
निदानार्थकरो रोगो रोगस्याप्युपलभ्यते ||१६||  
 +
<div class="mw-collapsible-content">
  
 
nidānārthakarō rōgō rōgasyāpyupalabhyatē||16||  
 
nidānārthakarō rōgō rōgasyāpyupalabhyatē||16||  
  
 
nidAnArthakaro rogo rogasyApyupalabhyate||16||  
 
nidAnArthakaro rogo rogasyApyupalabhyate||16||  
 +
</div></div>
  
 
Diseases can act as causative factors of other diseases as well [16]   
 
Diseases can act as causative factors of other diseases as well [16]   
 +
<div class="mw-collapsible mw-collapsed">
 +
 +
तद्यथा-
 +
 +
ज्वरसन्तापाद्रक्तपित्तमुदीर्यते |
  
तद्यथा- ज्वरसन्तापाद्रक्तपित्तमुदीर्यते |
 
 
रक्तपित्ताज्ज्वरस्ताभ्यां शोषश्चाप्युपजायते  ||१७||  
 
रक्तपित्ताज्ज्वरस्ताभ्यां शोषश्चाप्युपजायते  ||१७||  
 +
<div class="mw-collapsible-content">
 +
 +
tadyathā-
 +
 +
jvarasantāpādraktapittamudīryatē|
  
tadyathā- jvarasantāpādraktapittamudīryatē|
+
raktapittājjvarastābhyāṁ śōṣaścāpyupajāyatē ||17||
raktapittājjvarastābhyāṁ śōṣaścāpyupajāyatē ||17||  
+
 
 +
tadyathA -
 +
 
 +
jvarasantApAdraktapittamudIryate|
  
tadyathA - jvarasantApAdraktapittamudIryate|
 
 
raktapittAjjvarastAbhyAM shoShashcApyupajAyate ||17||
 
raktapittAjjvarastAbhyAM shoShashcApyupajAyate ||17||
 +
</div></div>
  
For example, elevated temperature in ''jwara'' can cause ''raktapitta'' and ''raktapitta'' can cause ''jwara''. Both the diseases (i.e ''jwara'' and ''raktapitta'') may lead to ''shosha'' (depletion of ''dhatus''). [17]  
+
For example, elevated temperature in ''[[jwara]]'' can cause ''raktapitta'' and ''raktapitta'' can cause ''[[jwara]]''. Both the diseases (i.e ''[[jwara]]'' and ''raktapitta'') may lead to ''shosha'' (depletion of ''[[dhatu]]s''). [17]  
 +
<div class="mw-collapsible mw-collapsed">
  
 
प्लीहाभिवृद्ध्या जठरं जठराच्छोथ एव च |  
 
प्लीहाभिवृद्ध्या जठरं जठराच्छोथ एव च |  
 +
 
अर्शोभ्यो जठरं दुःखं गुल्मश्चाप्युपजायते ||१८||  
 
अर्शोभ्यो जठरं दुःखं गुल्मश्चाप्युपजायते ||१८||  
 +
<div class="mw-collapsible-content">
  
 
plīhābhivr̥ddhyā jaṭharaṁ jaṭharācchōtha ēva ca|  
 
plīhābhivr̥ddhyā jaṭharaṁ jaṭharācchōtha ēva ca|  
 +
 
arśōbhyō jaṭharaṁ duḥkhaṁ gulmaścāpyupajāyatē||18||  
 
arśōbhyō jaṭharaṁ duḥkhaṁ gulmaścāpyupajāyatē||18||  
  
 
plIhAbhivRuddhyA jaTharaM jaTharAcchotha eva ca|  
 
plIhAbhivRuddhyA jaTharaM jaTharAcchotha eva ca|  
 +
 
arshobhyo jaTharaM duHkhaM gulmashcApyupajAyate||18||
 
arshobhyo jaTharaM duHkhaM gulmashcApyupajAyate||18||
 +
</div></div>
  
 
''Pleeha'' (enlargement of spleen) causes ''jathara'' (abdominal diseases including ascitis), which leads to ''shotha'' (generalized edema). ''Arsha'' (hemorrhoids) causes ''jathara'' (abdominal diseases including ascitis) that leads to ''gulma''  (abdominal lumps). [18]
 
''Pleeha'' (enlargement of spleen) causes ''jathara'' (abdominal diseases including ascitis), which leads to ''shotha'' (generalized edema). ''Arsha'' (hemorrhoids) causes ''jathara'' (abdominal diseases including ascitis) that leads to ''gulma''  (abdominal lumps). [18]
 +
<div class="mw-collapsible mw-collapsed">
  
 
प्रतिश्यायाद्भवेत् कासः कासात् सञ्जायते क्षयः |  
 
प्रतिश्यायाद्भवेत् कासः कासात् सञ्जायते क्षयः |  
 +
 
क्षयो रोगस्य हेतुत्वे शोषस्याप्युपलभ्यते ||१९||
 
क्षयो रोगस्य हेतुत्वे शोषस्याप्युपलभ्यते ||१९||
 +
<div class="mw-collapsible-content">
  
 
pratiśyāyādbhavēt kāsaḥ kāsāt sañjāyatē kṣayaḥ|  
 
pratiśyāyādbhavēt kāsaḥ kāsāt sañjāyatē kṣayaḥ|  
 +
 
kṣayō rōgasya hētutvē śōṣasyāpyupalabhyatē||19||
 
kṣayō rōgasya hētutvē śōṣasyāpyupalabhyatē||19||
  
 
pratishyAyAdbhavet kAsaH kAsAt sa~jjAyate kShayaH|  
 
pratishyAyAdbhavet kAsaH kAsAt sa~jjAyate kShayaH|  
 +
 
kShayo rogasya hetutve shoShasyApyupalabhyate||19||
 
kShayo rogasya hetutve shoShasyApyupalabhyate||19||
 +
</div></div>
  
''Pratishyaya'' (rhinitis) leads to ''kasa'' (cough) which further leads to ''kshaya'' (depletion of ''dhatu''), consequently resulting in ''sosha'' (emaciation). [19]
+
''Pratishyaya'' (rhinitis) leads to ''kasa'' (cough) which further leads to ''kshaya'' (depletion of ''[[dhatu]]''), consequently resulting in ''sosha'' (emaciation). [19]
 +
<div class="mw-collapsible mw-collapsed">
  
 
ते पूर्वं केवला रोगाः पश्चाद्धेत्वर्थकारिणः |  
 
ते पूर्वं केवला रोगाः पश्चाद्धेत्वर्थकारिणः |  
 +
 
उभयार्थकरा दृष्टास्तथैवैकार्थकारिणः [१] ||२०||  
 
उभयार्थकरा दृष्टास्तथैवैकार्थकारिणः [१] ||२०||  
 +
<div class="mw-collapsible-content">
  
 
tē pūrvaṁ kēvalā rōgāḥ paścāddhētvarthakāriṇaḥ|  
 
tē pūrvaṁ kēvalā rōgāḥ paścāddhētvarthakāriṇaḥ|  
 +
 
ubhayārthakarā dr̥ṣṭāstathaivaikārthakāriṇaḥ [1] ||20||
 
ubhayārthakarā dr̥ṣṭāstathaivaikārthakāriṇaḥ [1] ||20||
  
 
te pUrvaM kevalA rogAH pashcAddhetvarthakAriNaH|
 
te pUrvaM kevalA rogAH pashcAddhetvarthakAriNaH|
 +
 
ubhayArthakarA dRuShTAstathaivaikArthakAriNaH ||20||
 
ubhayArthakarA dRuShTAstathaivaikArthakAriNaH ||20||
 +
</div></div>
 +
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
 
Conditions in their primary stages or forms manifest themselves as diseases and subsequently act as causative factors for other diseases. They thus play a dual role - as a disease and as a causative factor. Some of these play just one role as well– either as a disease or as a causative factor. [20]
 
Conditions in their primary stages or forms manifest themselves as diseases and subsequently act as causative factors for other diseases. They thus play a dual role - as a disease and as a causative factor. Some of these play just one role as well– either as a disease or as a causative factor. [20]
 
</div>
 
</div>
 +
<div class="mw-collapsible mw-collapsed">
 +
 
कश्चिद्धि रोगो रोगस्य हेतुर्भूत्वा प्रशाम्यति |  
 
कश्चिद्धि रोगो रोगस्य हेतुर्भूत्वा प्रशाम्यति |  
 +
 
न प्रशाम्यति चाप्यन्यो हेत्वर्थं  कुरुतेऽपि च ||२१||  
 
न प्रशाम्यति चाप्यन्यो हेत्वर्थं  कुरुतेऽपि च ||२१||  
 +
<div class="mw-collapsible-content">
  
 
kaściddhi rōgō rōgasya hēturbhūtvā praśāmyati|  
 
kaściddhi rōgō rōgasya hēturbhūtvā praśāmyati|  
 +
 
na praśāmyati cāpyanyō hētvarthaṁ  kurutē'pi ca||21||
 
na praśāmyati cāpyanyō hētvarthaṁ  kurutē'pi ca||21||
  
 
kashciddhi rogo rogasya heturbhUtvA prashAmyati|
 
kashciddhi rogo rogasya heturbhUtvA prashAmyati|
 +
 
na prashAmyati cApyanyo hetvarthaM kurute~api ca ||21||
 
na prashAmyati cApyanyo hetvarthaM kurute~api ca ||21||
 +
</div></div>
  
 
Some diseases subside after causing another disease, while some do not subside even after causing another disease. [21]
 
Some diseases subside after causing another disease, while some do not subside even after causing another disease. [21]
 +
<div class="mw-collapsible mw-collapsed">
  
 
एवं कृच्छ्रतमा नॄणां दृश्यन्ते व्याधिसङ्कराः |  
 
एवं कृच्छ्रतमा नॄणां दृश्यन्ते व्याधिसङ्कराः |  
 +
 
प्रयोगापरिशुद्धत्वात्तथा चान्योन्यसम्भवात् ||२२||
 
प्रयोगापरिशुद्धत्वात्तथा चान्योन्यसम्भवात् ||२२||
 +
<div class="mw-collapsible-content">
  
 
ēvaṁ kr̥cchratamā nr̥̄ṇāṁ dr̥śyantē vyādhisaṅkarāḥ|  
 
ēvaṁ kr̥cchratamā nr̥̄ṇāṁ dr̥śyantē vyādhisaṅkarāḥ|  
 +
 
prayōgāpariśuddhatvāttathā cānyōnyasambhavāt||22||
 
prayōgāpariśuddhatvāttathā cānyōnyasambhavāt||22||
  
 
evaM kRucchratamA nRUNAM dRushyante vyAdhisa~gkarAH|
 
evaM kRucchratamA nRUNAM dRushyante vyAdhisa~gkarAH|
 +
 
prayogAparishuddhatvAttathA cAnyonyasambhavAt||22||
 
prayogAparishuddhatvAttathA cAnyonyasambhavAt||22||
 +
</div></div>
  
 
Combinations of diseases in human beings are usually very difficult to treat, owing to the complexity of the line of treatment, and their serving as causative factors of each other.  [22]
 
Combinations of diseases in human beings are usually very difficult to treat, owing to the complexity of the line of treatment, and their serving as causative factors of each other.  [22]
  
===== Ideal therapy without adverse effects =====
+
==== Ideal therapy without adverse effects ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
प्रयोगः शमयेद्व्याधिं योऽन्यमन्यमुदीरयेत् |  
 
प्रयोगः शमयेद्व्याधिं योऽन्यमन्यमुदीरयेत् |  
 +
 
नासौ विशुद्धः, शुद्धस्तु शमयेद्यो न कोपयेत् ||२३||  
 
नासौ विशुद्धः, शुद्धस्तु शमयेद्यो न कोपयेत् ||२३||  
 +
<div class="mw-collapsible-content">
  
 
prayōgaḥ śamayēdvyādhiṁ yō'nyamanyamudīrayēt|  
 
prayōgaḥ śamayēdvyādhiṁ yō'nyamanyamudīrayēt|  
 +
 
nāsau viśuddhaḥ, śuddhastu śamayēdyō na kōpayēt||23||
 
nāsau viśuddhaḥ, śuddhastu śamayēdyō na kōpayēt||23||
  
 
prayogaH shamayedvyAdhiM yo~anyamanyamudIrayet|
 
prayogaH shamayedvyAdhiM yo~anyamanyamudIrayet|
 +
 
nAsau vishuddhaH, shuddhastu shamayedyo na kopayet||23||
 
nAsau vishuddhaH, shuddhastu shamayedyo na kopayet||23||
 +
</div></div>
  
 
A therapy that alleviates one disease condition but provokes another disease is not ''shuddha'' (or is an impure or incorrect therapy). The ideal therapy is that which pacifies a disease without provoking any other disease. [23]
 
A therapy that alleviates one disease condition but provokes another disease is not ''shuddha'' (or is an impure or incorrect therapy). The ideal therapy is that which pacifies a disease without provoking any other disease. [23]
  
===== Diagnostic aspect of etiological factors =====
+
==== Diagnostic aspect of etiological factors ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
एको हेतुरनेकस्य तथैकस्यैक एव हि |  
 
एको हेतुरनेकस्य तथैकस्यैक एव हि |  
 +
 
व्याधेरेकस्य चानेको बहूनां बहवोऽपि च ||२४||  
 
व्याधेरेकस्य चानेको बहूनां बहवोऽपि च ||२४||  
 +
<div class="mw-collapsible-content">
  
 
ēkō hēturanēkasya tathaikasyaika ēva hi|  
 
ēkō hēturanēkasya tathaikasyaika ēva hi|  
 +
 
vyādhērēkasya cānēkō bahūnāṁ bahavō'pi ca||24||  
 
vyādhērēkasya cānēkō bahūnāṁ bahavō'pi ca||24||  
  
 
eko heturanekasya tathaikasyaika eva hi|
 
eko heturanekasya tathaikasyaika eva hi|
 +
 
vyAdherekasya cAneko bahUnAM bahavo~api ca||24||
 
vyAdherekasya cAneko bahUnAM bahavo~api ca||24||
 +
</div></div>
  
 
One causative factor may cause one or many diseases. Many causative factors may result in a single disease or may cause several diseases. [24]  
 
One causative factor may cause one or many diseases. Many causative factors may result in a single disease or may cause several diseases. [24]  
 +
<div class="mw-collapsible mw-collapsed">
  
 
ज्वरभ्रमप्रलापाद्या दृश्यन्ते रूक्षहेतुजाः |  
 
ज्वरभ्रमप्रलापाद्या दृश्यन्ते रूक्षहेतुजाः |  
 +
 
रूक्षेणैकेन चाप्येको ज्वर एवोपजायते ||२५||  
 
रूक्षेणैकेन चाप्येको ज्वर एवोपजायते ||२५||  
 +
<div class="mw-collapsible-content">
  
 
jvarabhramapralāpādyā dr̥śyantē rūkṣahētujāḥ|  
 
jvarabhramapralāpādyā dr̥śyantē rūkṣahētujāḥ|  
 +
 
rūkṣēṇaikēna cāpyēkō jvara ēvōpajāyatē||25||  
 
rūkṣēṇaikēna cāpyēkō jvara ēvōpajāyatē||25||  
  
 
jvarabhramapralApAdyA dRushyante rUkShahetujAH|
 
jvarabhramapralApAdyA dRushyante rUkShahetujAH|
 +
 
rUkSheNaikena cApyeko jvara evopajAyate||25||
 
rUkSheNaikena cApyeko jvara evopajAyate||25||
 +
</div></div>
  
It is seen that a single causative factor, ruksha (dry) can cause many diseases such as ''jwara'' (fever), ''bhrama'' (vertigo) and ''pralapa'' (delirium) etc., while the same single factor (''ruksha'') may cause just one disease (''jwara'') [25]  
+
It is seen that a single causative factor, ruksha (dry) can cause many diseases such as ''[[jwara]]'' (fever), ''bhrama'' (vertigo) and ''pralapa'' (delirium) etc., while the same single factor (''ruksha'') may cause just one disease (''[[jwara]]'') [25]  
 +
<div class="mw-collapsible mw-collapsed">
  
 
हेतुभिर्बहुभिश्चैको ज्वरो रूक्षादिभिर्भवेत् |  
 
हेतुभिर्बहुभिश्चैको ज्वरो रूक्षादिभिर्भवेत् |  
 +
 
रूक्षादिभिर्ज्वराद्याश्च व्याधयः सम्भवन्ति हि ||२६||  
 
रूक्षादिभिर्ज्वराद्याश्च व्याधयः सम्भवन्ति हि ||२६||  
 +
<div class="mw-collapsible-content">
  
 
hētubhirbahubhiścaikō jvarō rūkṣādibhirbhavēt|  
 
hētubhirbahubhiścaikō jvarō rūkṣādibhirbhavēt|  
 +
 
rūkṣādibhirjvarādyāśca vyādhayaḥ sambhavanti hi||26||
 
rūkṣādibhirjvarādyāśca vyādhayaḥ sambhavanti hi||26||
  
 
hetubhirbahubhishcaiko jvaro rUkShAdibhirbhavet|
 
hetubhirbahubhishcaiko jvaro rUkShAdibhirbhavet|
 +
 
rUkShAdibhirjvarAdyAshca vyAdhayaH sambhavanti hi||26||
 
rUkShAdibhirjvarAdyAshca vyAdhayaH sambhavanti hi||26||
 +
</div></div>
  
''Jwara'' alone may be caused by a combination of several causative factors including but not limited to ''ruksha''(dry) etc. and many causes like, ''ruksha'' (dry, rough) etc. may lead to several diseases. [26]
+
''[[Jwara]]'' alone may be caused by a combination of several causative factors including but not limited to ''ruksha''(dry) etc. and many causes like, ''ruksha'' (dry, rough) etc. may lead to several diseases. [26]
  
===== Diagnostic aspect of symptoms =====
+
==== Diagnostic aspect of symptoms ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
लिङ्गं चैकमनेकस्य तथैवैकस्य  लक्ष्यते |  
 
लिङ्गं चैकमनेकस्य तथैवैकस्य  लक्ष्यते |  
 +
 
बहून्येकस्य च व्याधेर्बहूनां स्युर्बहूनि  च ||२७||  
 
बहून्येकस्य च व्याधेर्बहूनां स्युर्बहूनि  च ||२७||  
 +
<div class="mw-collapsible-content">
  
 
liṅgaṁ caikamanēkasya tathaivaikasya  lakṣyatē|  
 
liṅgaṁ caikamanēkasya tathaivaikasya  lakṣyatē|  
 +
 
bahūnyēkasya ca vyādhērbahūnāṁ syurbahūni  ca||27||  
 
bahūnyēkasya ca vyādhērbahūnāṁ syurbahūni  ca||27||  
  
 
li~ggaM caikamanekasya tathaivaikasya lakShyate|
 
li~ggaM caikamanekasya tathaivaikasya lakShyate|
 +
 
bahUnyekasya ca vyAdherbahUnAM syurbahUni ca||27||
 
bahUnyekasya ca vyAdherbahUnAM syurbahUni ca||27||
 +
</div></div>
  
 
Similarly, one symptom may be common to many diseases, one symptom may be related to only one disease, many symptoms may be associated with only one disease, and many symptoms may be common to many diseases. [27]  
 
Similarly, one symptom may be common to many diseases, one symptom may be related to only one disease, many symptoms may be associated with only one disease, and many symptoms may be common to many diseases. [27]  
 +
<div class="mw-collapsible mw-collapsed">
  
 
विषमारम्भमूलानां लिङ्गमेकं ज्वरो मतः |  
 
विषमारम्भमूलानां लिङ्गमेकं ज्वरो मतः |  
 +
 
ज्वरस्यैकस्य चाप्येकः सन्तापो लिङ्गमुच्यते ||२८||  
 
ज्वरस्यैकस्य चाप्येकः सन्तापो लिङ्गमुच्यते ||२८||  
 +
<div class="mw-collapsible-content">
  
 
viṣamārambhamūlānāṁ liṅgamēkaṁ jvarō mataḥ|  
 
viṣamārambhamūlānāṁ liṅgamēkaṁ jvarō mataḥ|  
 +
 
jvarasyaikasya cāpyēkaḥ santāpō liṅgamucyatē||28||  
 
jvarasyaikasya cāpyēkaḥ santāpō liṅgamucyatē||28||  
  
 
viShamArambhamUlAnAM li~ggamekaM jvaro mataH|
 
viShamArambhamUlAnAM li~ggamekaM jvaro mataH|
 +
 
jvarasyaikasya cApyekaH santApo li~ggamucyate||28||
 
jvarasyaikasya cApyekaH santApo li~ggamucyate||28||
 +
</div></div>
  
One symptom i.e. ''jwara'' can be considered common to many diseases that have irregular onset, while ''santapa'' (elevated temperature) is considered a symptom of only one disease i.e. ''jwara''.[28]  
+
One symptom i.e. ''[[jwara]]'' can be considered common to many diseases that have irregular onset, while ''santapa'' (elevated temperature) is considered a symptom of only one disease i.e. ''[[jwara]]''.[28]  
 +
<div class="mw-collapsible mw-collapsed">
  
 
विषमारम्भमूलैश्च ज्वर एको निरुच्यते |  
 
विषमारम्भमूलैश्च ज्वर एको निरुच्यते |  
 +
 
लिङ्गैरेतैर्ज्वरश्वासहिक्काद्याः सन्ति चामयाः ||२९||  
 
लिङ्गैरेतैर्ज्वरश्वासहिक्काद्याः सन्ति चामयाः ||२९||  
 +
<div class="mw-collapsible-content">
  
viṣamārambhamūlaiśca jvara ēkō nirucyatē|  
+
viṣamārambhamūlaiśca jvara ēkō nirucyatē|
 +
 
liṅgairētairjvaraśvāsahikkādyāḥ santi cāmayāḥ||29||
 
liṅgairētairjvaraśvāsahikkādyāḥ santi cāmayāḥ||29||
  
 
viShamArambhamUlaishca jvara eko nirucyate|
 
viShamArambhamUlaishca jvara eko nirucyate|
 +
 
li~ggairetairjvarashvAsahikkAdyAH santi cAmayAH||29||
 
li~ggairetairjvarashvAsahikkAdyAH santi cAmayAH||29||
 +
</div></div>
  
Irregular onset (and similar other symptoms) appear in the case of ''jwara'', while similar symptoms also occur in ''shwasa'' (dyspnea), ''hikka'' (hiccups), and other similar diseases. [29]
+
Irregular onset (and similar other symptoms) appear in the case of ''[[jwara]]'', while similar symptoms also occur in ''shwasa'' (dyspnea), ''hikka'' (hiccups), and other similar diseases. [29]
  
===== Therapeutic considerations =====
+
==== Therapeutic considerations ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
एका शान्तिरनेकस्य तथैवैकस्य  लक्ष्यते |  
 
एका शान्तिरनेकस्य तथैवैकस्य  लक्ष्यते |  
 +
 
व्याधेरेकस्य चानेका बहूनां बह्व्य एव च ||३०||  
 
व्याधेरेकस्य चानेका बहूनां बह्व्य एव च ||३०||  
 +
<div class="mw-collapsible-content">
 +
 +
ēkā śāntiranēkasya tathaivaikasya lakṣyatē|
  
ēkā śāntiranēkasya tathaivaikasya  lakṣyatē|
 
 
vyādhērēkasya cānēkā bahūnāṁ bahvya ēva ca||30||  
 
vyādhērēkasya cānēkā bahūnāṁ bahvya ēva ca||30||  
  
 
ekA shAntiranekasya tathaivaikasya lakShyate|
 
ekA shAntiranekasya tathaivaikasya lakShyate|
 +
 
vyAdherekasya cAnekA bahUnAM bahvya eva ca||30||
 
vyAdherekasya cAnekA bahUnAM bahvya eva ca||30||
 +
</div></div>
  
 
A single therapy can subside many diseases as well as a single disease. Multiple therapies may be needed to subside many diseases, whereas one disease could require multiple therapies to cure. [30]  
 
A single therapy can subside many diseases as well as a single disease. Multiple therapies may be needed to subside many diseases, whereas one disease could require multiple therapies to cure. [30]  
 +
<div class="mw-collapsible mw-collapsed">
  
 
शान्तिरामाशयोत्थानां व्याधीनां लङ्घनक्रिया |  
 
शान्तिरामाशयोत्थानां व्याधीनां लङ्घनक्रिया |  
 +
 
ज्वरस्यैकस्य चाप्येका शान्तिर्लङ्घनमुच्यते ||३१||  
 
ज्वरस्यैकस्य चाप्येका शान्तिर्लङ्घनमुच्यते ||३१||  
 +
<div class="mw-collapsible-content">
  
 
śāntirāmāśayōtthānāṁ vyādhīnāṁ laṅghanakriyā|  
 
śāntirāmāśayōtthānāṁ vyādhīnāṁ laṅghanakriyā|  
 +
 
jvarasyaikasya cāpyēkā śāntirlaṅghanamucyatē||31||  
 
jvarasyaikasya cāpyēkā śāntirlaṅghanamucyatē||31||  
  
 
shAntirAmAshayotthAnAM vyAdhInAM la~gghanakriyA|  
 
shAntirAmAshayotthAnAM vyAdhInAM la~gghanakriyA|  
 +
 
jvarasyaikasya cApyekA shAntirla~gghanamucyate||31||
 
jvarasyaikasya cApyekA shAntirla~gghanamucyate||31||
 +
</div></div>
 +
 +
The diseases originating from ''amashaya'' are cured by ''[[langhana]]'' (fasting), only whereas only a single disease entity ''[[jwara]]'' also can be treated by the single therapy of ''[[langhana]]'' (fasting). [31]
 +
<div class="mw-collapsible mw-collapsed">
  
The diseases originating from ''amashaya'' are cured by ''langhana'' (fasting), only whereas only a single disease entity ''jwara'' also can be treated by the single therapy of ''langhana'' (fasting). [31]
 
 
 
तथा लघ्वशनाद्याश्च ज्वरस्यैकस्य शान्तयः |  
 
तथा लघ्वशनाद्याश्च ज्वरस्यैकस्य शान्तयः |  
 +
 
एताश्चैव ज्वरश्वासहिक्कादीनां प्रशान्तयः ||३२||  
 
एताश्चैव ज्वरश्वासहिक्कादीनां प्रशान्तयः ||३२||  
 +
<div class="mw-collapsible-content">
  
 
tathā laghvaśanādyāśca jvarasyaikasya śāntayaḥ|  
 
tathā laghvaśanādyāśca jvarasyaikasya śāntayaḥ|  
 +
 
ētāścaiva jvaraśvāsahikkādīnāṁ praśāntayaḥ||32||
 
ētāścaiva jvaraśvāsahikkādīnāṁ praśāntayaḥ||32||
  
 
tathA laghvashanAdyAshca jvarasyaikasya shAntayaH|
 
tathA laghvashanAdyAshca jvarasyaikasya shAntayaH|
 +
 
etAshcaiva jvarashvAsahikkAdInAM prashAntayaH||32||
 
etAshcaiva jvarashvAsahikkAdInAM prashAntayaH||32||
 +
</div></div>
  
For treating a single disease like ''jwara'', multiple therapies like light diet, etc. are needed and the same multiple therapies like light diet etc. are needed to subside many diseases like ''jwara''(fever), ''shwasa''(dyspnea), ''hikka''(hiccups) etc. [32]
+
For treating a single disease like ''[[jwara]]'', multiple therapies like light diet, etc. are needed and the same multiple therapies like light diet etc. are needed to subside many diseases like ''[[jwara]]''(fever), ''shwasa''(dyspnea), ''hikka''(hiccups) etc. [32]
  
===== Prognostic aspect in therapy =====
+
==== Prognostic aspect in therapy ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
सुखसाध्यः सुखोपायः कालेनाल्पेन साध्यते |  
 
सुखसाध्यः सुखोपायः कालेनाल्पेन साध्यते |  
 +
 
साध्यते कृच्छ्रसाध्यस्तु यत्नेन महता चिरात् ||३३||  
 
साध्यते कृच्छ्रसाध्यस्तु यत्नेन महता चिरात् ||३३||  
  
 
याति नाशेषतां व्याधिरसाध्यो याप्यसञ्ज्ञितः |  
 
याति नाशेषतां व्याधिरसाध्यो याप्यसञ्ज्ञितः |  
 +
 
परोऽसाध्यः क्रियाः सर्वाः प्रत्याख्येयोऽतिवर्तते ||३४||  
 
परोऽसाध्यः क्रियाः सर्वाः प्रत्याख्येयोऽतिवर्तते ||३४||  
  
नासाध्यः साध्यतां याति साध्यो याति त्वसाध्यताम् |  
+
नासाध्यः साध्यतां याति साध्यो याति त्वसाध्यताम् |
 +
 
पादापचाराद्दैवाद्वा यान्ति भावान्तरं गदाः ||३५||
 
पादापचाराद्दैवाद्वा यान्ति भावान्तरं गदाः ||३५||
 +
<div class="mw-collapsible-content">
  
 
sukhasādhyaḥ sukhōpāyaḥ kālēnālpēna sādhyatē|  
 
sukhasādhyaḥ sukhōpāyaḥ kālēnālpēna sādhyatē|  
 +
 
sādhyatē kr̥cchrasādhyastu yatnēna mahatā cirāt||33||  
 
sādhyatē kr̥cchrasādhyastu yatnēna mahatā cirāt||33||  
  
 
yāti nāśēṣatāṁ vyādhirasādhyō yāpyasañjñitaḥ|  
 
yāti nāśēṣatāṁ vyādhirasādhyō yāpyasañjñitaḥ|  
 +
 
parō'sādhyaḥ kriyāḥ sarvāḥ pratyākhyēyō'tivartatē||34||  
 
parō'sādhyaḥ kriyāḥ sarvāḥ pratyākhyēyō'tivartatē||34||  
  
 
nāsādhyaḥ sādhyatāṁ yāti sādhyō yāti tvasādhyatām|  
 
nāsādhyaḥ sādhyatāṁ yāti sādhyō yāti tvasādhyatām|  
 +
 
pādāpacārāddaivādvā yānti bhāvāntaraṁ gadāḥ||35||
 
pādāpacārāddaivādvā yānti bhāvāntaraṁ gadāḥ||35||
  
 
sukhasAdhyaH sukhopAyaH kAlenAlpena sAdhyate|
 
sukhasAdhyaH sukhopAyaH kAlenAlpena sAdhyate|
 +
 
sAdhyate kRucchrasAdhyastu yatnena mahatA cirAt||33||
 
sAdhyate kRucchrasAdhyastu yatnena mahatA cirAt||33||
  
 
yAti nAsheShatAM vyAdhirasAdhyo yApyasa~jj~jitaH|
 
yAti nAsheShatAM vyAdhirasAdhyo yApyasa~jj~jitaH|
 +
 
paro~asAdhyaH kriyAH sarvAH pratyAkhyeyo~ativartate||34||
 
paro~asAdhyaH kriyAH sarvAH pratyAkhyeyo~ativartate||34||
  
 
nAsAdhyaH sAdhyatAM yAti sAdhyo yAti tvasAdhyatAm|
 
nAsAdhyaH sAdhyatAM yAti sAdhyo yAti tvasAdhyatAm|
 +
 
pAdApacArAddaivAdvA yAnti bhAvAntaraM gadAH||35||
 
pAdApacArAddaivAdvA yAnti bhAvAntaraM gadAH||35||
 +
</div></div>
 +
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
 
Easily curable diseases can be managed in a short time by simple measures. Diseases which are difficult to cure may require more effort and time to cure. The palliable variety of incurable diseases can never be cured, but can be alleviated. Incurable diseases are not amenable to any type of treatment.  
 
Easily curable diseases can be managed in a short time by simple measures. Diseases which are difficult to cure may require more effort and time to cure. The palliable variety of incurable diseases can never be cured, but can be alleviated. Incurable diseases are not amenable to any type of treatment.  
Line 484: Line 711:
 
Conversely, incurable diseases never become curable, while the curable varieties may become incurable due to factors like incompetence of the four components of health management (the physician, the medicine, the attendant and the patient) and/or misfortune. The easily curable kinds may also become difficult to cure, if not incurable, while diseases that are difficult to cure may become palliable and palliable variety may become incurable. [33-35]
 
Conversely, incurable diseases never become curable, while the curable varieties may become incurable due to factors like incompetence of the four components of health management (the physician, the medicine, the attendant and the patient) and/or misfortune. The easily curable kinds may also become difficult to cure, if not incurable, while diseases that are difficult to cure may become palliable and palliable variety may become incurable. [33-35]
 
</div>
 
</div>
===== Examination of stages of disease =====
+
 
 +
==== Examination of stages of disease ====
 +
<div class="mw-collapsible mw-collapsed">
  
 
वृद्धिस्थानक्षयावस्थां रोगाणामुपलक्षयेत्  |  
 
वृद्धिस्थानक्षयावस्थां रोगाणामुपलक्षयेत्  |  
 +
 
सुसूक्ष्मामपि च प्राज्ञो देहाग्निबलचेतसाम् ||३६||  
 
सुसूक्ष्मामपि च प्राज्ञो देहाग्निबलचेतसाम् ||३६||  
 +
<div class="mw-collapsible-content">
  
 
vr̥ddhisthānakṣayāvasthāṁ rōgāṇāmupalakṣayēt |  
 
vr̥ddhisthānakṣayāvasthāṁ rōgāṇāmupalakṣayēt |  
 +
 
susūkṣmāmapi ca prājñō dēhāgnibalacētasām||36||  
 
susūkṣmāmapi ca prājñō dēhāgnibalacētasām||36||  
  
 
vRuddhisthAnakShayAvasthAM rogANAmupalakShayet |
 
vRuddhisthAnakShayAvasthAM rogANAmupalakShayet |
 +
 
susUkShmAmapi ca prAj~jo dehAgnibalacetasAm||36||
 
susUkShmAmapi ca prAj~jo dehAgnibalacetasAm||36||
 +
</div></div>
  
 
A wise physician should carefully observe the subtle changes in the state of diseases (aggravated, normal and diminished) while properly assessing the patient’s body strength, digestive power and mental ability. [36]
 
A wise physician should carefully observe the subtle changes in the state of diseases (aggravated, normal and diminished) while properly assessing the patient’s body strength, digestive power and mental ability. [36]
 +
<div class="mw-collapsible mw-collapsed">
  
 
व्याध्यवस्थाविशेषान् हि ज्ञात्वा ज्ञात्वा विचक्षणः |  
 
व्याध्यवस्थाविशेषान् हि ज्ञात्वा ज्ञात्वा विचक्षणः |  
 +
 
तस्यां तस्यामवस्थायां चतुःश्रेयः  प्रपद्यते ||३७||  
 
तस्यां तस्यामवस्थायां चतुःश्रेयः  प्रपद्यते ||३७||  
 +
<div class="mw-collapsible-content">
  
 
vyādhyavasthāviśēṣān hi jñātvā jñātvā vicakṣaṇaḥ|  
 
vyādhyavasthāviśēṣān hi jñātvā jñātvā vicakṣaṇaḥ|  
 +
 
tasyāṁ tasyāmavasthāyāṁ catuḥśrēyaḥ prapadyatē||37||
 
tasyāṁ tasyāmavasthāyāṁ catuḥśrēyaḥ prapadyatē||37||
  
 
vyAdhyavasthAvisheShAn hi j~jAtvA j~jAtvA vicakShaNaH|
 
vyAdhyavasthAvisheShAn hi j~jAtvA j~jAtvA vicakShaNaH|
 +
 
tasyAM tasyAmavasthAyAM catuHshreyaH prapadyate||37||
 
tasyAM tasyAmavasthAyAM catuHshreyaH prapadyate||37||
 +
</div></div>
  
 
The physician, who is keenly observing variations in disease stages in the patient, should know it (the disease) well and prescribe such a treatment that would be helpful in attaining the fourfold effect of therapeutics. [37]   
 
The physician, who is keenly observing variations in disease stages in the patient, should know it (the disease) well and prescribe such a treatment that would be helpful in attaining the fourfold effect of therapeutics. [37]   
 +
<div class="mw-collapsible mw-collapsed">
  
 
प्रायस्तिर्यग्गता दोषाः क्लेशयन्त्यातुरांश्चिरम् |  
 
प्रायस्तिर्यग्गता दोषाः क्लेशयन्त्यातुरांश्चिरम् |  
 +
 
तेषु  न त्वरया कुर्याद्देहाग्निबलवित् क्रियाम् ||३८||  
 
तेषु  न त्वरया कुर्याद्देहाग्निबलवित् क्रियाम् ||३८||  
  
 
प्रयोगैः क्षपयेद्वा तान् सुखं वा कोष्ठमानयेत् |  
 
प्रयोगैः क्षपयेद्वा तान् सुखं वा कोष्ठमानयेत् |  
 +
 
ज्ञात्वा कोष्ठप्रपन्नांस्तान् यथासन्नं  हरेद्बुधः ||३९||  
 
ज्ञात्वा कोष्ठप्रपन्नांस्तान् यथासन्नं  हरेद्बुधः ||३९||  
 +
<div class="mw-collapsible-content">
  
 
prāyastiryaggatā dōṣāḥ klēśayantyāturāṁściram|  
 
prāyastiryaggatā dōṣāḥ klēśayantyāturāṁściram|  
tēṣu na tvarayā kuryāddēhāgnibalavit kriyām||38||  
+
 
 +
tēṣu na tvarayā kuryāddēhāgnibalavit kriyām||38||  
  
 
prayōgaiḥ kṣapayēdvā tān sukhaṁ vā kōṣṭhamānayēt|  
 
prayōgaiḥ kṣapayēdvā tān sukhaṁ vā kōṣṭhamānayēt|  
 +
 
jñātvā kōṣṭhaprapannāṁstān yathāsannaṁ  harēdbudhaḥ||39||
 
jñātvā kōṣṭhaprapannāṁstān yathāsannaṁ  harēdbudhaḥ||39||
  
 
prAyastiryaggatA doShAH kleshayantyAturAMshciram|
 
prAyastiryaggatA doShAH kleshayantyAturAMshciram|
 +
 
teShu na tvarayA kuryAddehAgnibalavit kriyAm||38||
 
teShu na tvarayA kuryAddehAgnibalavit kriyAm||38||
  
 
prayogaiH kShapayedvA tAn sukhaM vA koShThamAnayet|
 
prayogaiH kShapayedvA tAn sukhaM vA koShThamAnayet|
 +
 
j~jAtvA koShThaprapannAMstAn yathAsannaM haredbudhaH||39||
 
j~jAtvA koShThaprapannAMstAn yathAsannaM haredbudhaH||39||
 +
</div></div>
 +
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
Generally, ''doshas'' that are spread over obliquely (in the transverse direction) afflict the patient for a longer time. In that condition, treatment should not be initiated in a hurry without proper assessment of body strength and digestive power.  
+
Generally, ''[[dosha]]s'' that are spread over obliquely (in the transverse direction) afflict the patient for a longer time. In that condition, treatment should not be initiated in a hurry without proper assessment of body strength and digestive power.  
These ''doshas'' should be alleviated first by treatment, or they should be carefully be drawn to the ''koshtha'' (bowel). After knowing their status in ''koshtha'', the wise physician should eliminate them through the nearest route. [38-39]  
+
These ''[[dosha]]s'' should be alleviated first by treatment, or they should be carefully be drawn to the ''koshtha'' (bowel). After knowing their status in ''koshtha'', the wise physician should eliminate them through the nearest route. [38-39]  
 
</div>
 
</div>
 +
<div class="mw-collapsible mw-collapsed">
 +
 
ज्ञानार्थं यानि चोक्तानि व्याधिलिङ्गानि सङ्ग्रहे |  
 
ज्ञानार्थं यानि चोक्तानि व्याधिलिङ्गानि सङ्ग्रहे |  
 +
 
व्याधयस्ते तदात्वे तु लिङ्गानीष्टानि नामयाः ||४०||
 
व्याधयस्ते तदात्वे तु लिङ्गानीष्टानि नामयाः ||४०||
 +
<div class="mw-collapsible-content">
  
 
jñānārthaṁ yāni cōktāni vyādhiliṅgāni saṅgrahē|  
 
jñānārthaṁ yāni cōktāni vyādhiliṅgāni saṅgrahē|  
 +
 
vyādhayastē tadātvē tu liṅgānīṣṭāni nāmayāḥ||40||  
 
vyādhayastē tadātvē tu liṅgānīṣṭāni nāmayāḥ||40||  
  
 
j~jAnArthaM yAni coktAni vyAdhili~ggAni sa~ggrahe|
 
j~jAnArthaM yAni coktAni vyAdhili~ggAni sa~ggrahe|
 +
 
vyAdhayaste tadAtve tu li~ggAnIShTAni nAmayAH||40||
 
vyAdhayaste tadAtve tu li~ggAnIShTAni nAmayAH||40||
 +
</div></div>
 +
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
In the [[Nidana Sthana]], a compendium of symptomatology has been provided as a reckoner for the Ayurveda practitioner to gain adequate knowledge of some of the major classes of diseases and diagnose them effectively. But these symptoms may independently develop into diseases and create emergency situations. [40]
+
In the [[Nidana Sthana]], a compendium of symptomatology has been provided as a reckoner for the [[Ayurveda]] practitioner to gain adequate knowledge of some of the major classes of diseases and diagnose them effectively. But these symptoms may independently develop into diseases and create emergency situations. [40]
 
</div>
 
</div>
 +
<div class="mw-collapsible mw-collapsed">
 +
 
विकारः प्रकृतिश्चैव द्वयं सर्वं समासतः |  
 
विकारः प्रकृतिश्चैव द्वयं सर्वं समासतः |  
 +
 
तद्धेतुवशगं हेतोरभावान्नानुवर्तते ||४१||  
 
तद्धेतुवशगं हेतोरभावान्नानुवर्तते ||४१||  
 +
<div class="mw-collapsible-content">
  
 
vikāraḥ prakr̥tiścaiva dvayaṁ sarvaṁ samāsataḥ|  
 
vikāraḥ prakr̥tiścaiva dvayaṁ sarvaṁ samāsataḥ|  
 +
 
taddhētuvaśagaṁ hētōrabhāvānnānuvartatē||41||
 
taddhētuvaśagaṁ hētōrabhāvānnānuvartatē||41||
  
 
vikAraH prakRutishcaiva dvayaM sarvaM samAsataH|
 
vikAraH prakRutishcaiva dvayaM sarvaM samAsataH|
 +
 
taddhetuvashagaM hetorabhAvAnnAnuvartate||41||
 
taddhetuvashagaM hetorabhAvAnnAnuvartate||41||
 +
</div></div>
  
 
Everything can be categorized into being in a normal or an abnormal state. Both of these categories depend upon causes. Nothing can happen without a cause. [41]
 
Everything can be categorized into being in a normal or an abnormal state. Both of these categories depend upon causes. Nothing can happen without a cause. [41]
  
==== Summary ====
+
=== Summary ===
 +
<div class="mw-collapsible mw-collapsed">
 +
 
 +
तत्र श्लोकाः-
 +
 
 +
हेतवः पूर्वरूपाणि रूपाण्युपशयस्तथा |
  
तत्र श्लोकाः- हेतवः पूर्वरूपाणि रूपाण्युपशयस्तथा |
 
 
सम्प्राप्तिः पूर्वमुत्पत्तिः सूत्रमात्रं चिकित्सितात् ||४२||  
 
सम्प्राप्तिः पूर्वमुत्पत्तिः सूत्रमात्रं चिकित्सितात् ||४२||  
  
 
ज्वरादीनां विकाराणामष्टानां साध्यता न च |  
 
ज्वरादीनां विकाराणामष्टानां साध्यता न च |  
 +
 
पृथगेकैकशश्चोक्ता हेतुलिङ्गोपशान्तयः ||४३||  
 
पृथगेकैकशश्चोक्ता हेतुलिङ्गोपशान्तयः ||४३||  
  
 
हेतुपर्यायनामानि व्याधीनां लक्षणस्य च |  
 
हेतुपर्यायनामानि व्याधीनां लक्षणस्य च |  
 +
 
निदानस्थानमेतावत् सङ्ग्रहेणोपदिश्यते ||४४||  
 
निदानस्थानमेतावत् सङ्ग्रहेणोपदिश्यते ||४४||  
 +
<div class="mw-collapsible-content">
  
 
tatra ślōkāḥ-  
 
tatra ślōkāḥ-  
 +
 
hētavaḥ pūrvarūpāṇi rūpāṇyupaśayastathā|  
 
hētavaḥ pūrvarūpāṇi rūpāṇyupaśayastathā|  
 +
 
samprāptiḥ pūrvamutpattiḥ sūtramātraṁ cikitsitāt||42||  
 
samprāptiḥ pūrvamutpattiḥ sūtramātraṁ cikitsitāt||42||  
  
 
jvarādīnāṁ vikārāṇāmaṣṭānāṁ sādhyatā na ca|  
 
jvarādīnāṁ vikārāṇāmaṣṭānāṁ sādhyatā na ca|  
 +
 
pr̥thagēkaikaśaścōktā hētuliṅgōpaśāntayaḥ||43||  
 
pr̥thagēkaikaśaścōktā hētuliṅgōpaśāntayaḥ||43||  
  
 
hētuparyāyanāmāni vyādhīnāṁ lakṣaṇasya ca|  
 
hētuparyāyanāmāni vyādhīnāṁ lakṣaṇasya ca|  
 +
 
nidānasthānamētāvat saṅgrahēṇōpadiśyatē||44||
 
nidānasthānamētāvat saṅgrahēṇōpadiśyatē||44||
  
 
tatra shlokAH-
 
tatra shlokAH-
 +
 
hetavaH pUrvarUpANi rUpANyupashayastathA|
 
hetavaH pUrvarUpANi rUpANyupashayastathA|
 +
 
samprAptiH pUrvamutpattiH sUtramAtraM cikitsitAt||42||
 
samprAptiH pUrvamutpattiH sUtramAtraM cikitsitAt||42||
  
 
jvarAdInAM vikArANAmaShTAnAM sAdhyatA na ca|
 
jvarAdInAM vikArANAmaShTAnAM sAdhyatA na ca|
 +
 
pRuthagekaikashashcoktA hetuli~ggopashAntayaH||43||
 
pRuthagekaikashashcoktA hetuli~ggopashAntayaH||43||
  
 
hetuparyAyanAmAni vyAdhInAM lakShaNasya ca|
 
hetuparyAyanAmAni vyAdhInAM lakShaNasya ca|
 +
 
nidAnasthAnametAvat sa~ggraheNopadishyate||44||
 
nidAnasthAnametAvat sa~ggraheNopadishyate||44||
 +
</div></div>
 +
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
To sum up this chapter, etiological factors, premonitory symptoms, signs and symptoms, therapeutic relief, pathogenesis, historical origins and brief line of treatment of ''apasmara'' have been described in this section. Since this is the concluding chapter of the [[Nidana Sthana]], a summary to the entire section has also been provided here, stating that starting from ''jwara'' all eight diseases have been dealt with separately in eight chapters, each with etiological factors, symptomatology, prognosis and brief line of management.  
+
To sum up this chapter, etiological factors, premonitory symptoms, signs and symptoms, therapeutic relief, pathogenesis, historical origins and brief line of treatment of apasmara have been described in this section. Since this is the concluding chapter of the [[Nidana Sthana]], a summary to the entire section has also been provided here, stating that starting from ''[[jwara]]'' all eight diseases have been dealt with separately in eight chapters, each with etiological factors, symptomatology, prognosis and brief line of management.  
  
 
A compendium of diseases with etiological factors, their synonyms, symptoms of the diseases have been provided as an epilogue to the chapter. [42-44]
 
A compendium of diseases with etiological factors, their synonyms, symptoms of the diseases have been provided as an epilogue to the chapter. [42-44]
 
</div>
 
</div>
 +
<div class="mw-collapsible mw-collapsed">
 +
 
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने अपस्मारनिदानं नामाष्टमोऽध्यायः |  
 
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने अपस्मारनिदानं नामाष्टमोऽध्यायः |  
 +
 
निदानस्थानं समाप्तम् ||८||  
 
निदानस्थानं समाप्तम् ||८||  
 +
<div class="mw-collapsible-content">
  
 
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē  
 
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē  
 +
 
apasmāranidānaṁ nāmāṣṭamō'dhyāyaḥ||8||  
 
apasmāranidānaṁ nāmāṣṭamō'dhyāyaḥ||8||  
  
 
iti carakasaṁhitāyāṁ dvitīyaṁ nidānasthānaṁ samāptam|
 
iti carakasaṁhitāyāṁ dvitīyaṁ nidānasthānaṁ samāptam|
 +
</div></div>
  
Thus, ends the eighth chapter on the ‘diagnosis of ''apasmara''” of the section “Diagnosis of diseases” ([[Nidana Sthana]]) of Agnivesha , as redacted by Charaka.
 
  
=== ''Tattva Vimarsha'' ===
+
Thus, ends the eighth chapter on the ‘diagnosis of apasmara” of the section “Diagnosis of diseases” ([[Nidana Sthana]]) of Agnivesha , as redacted by Charak.
 +
 
 +
== Tattva Vimarsha (Fundamental Principles) ==
 
<div style="text-align:justify;">  
 
<div style="text-align:justify;">  
*''Apasmara'' is a disease due to vitiation of three ''sharira doshas'' and two ''manas doshas''.  
+
*Apasmara is a disease due to vitiation of three ''sharira [[dosha]]s'' and two ''[[manas]] [[dosha]]s''.  
*The causative factors of ''apasmara'' mainly include consuming unhygienic, impure, decomposed food and encountering inauspicious things that are not compatible with one’s sensibilities.  
+
*The causative factors of apasmara mainly include consuming unhygienic, impure, decomposed food and encountering inauspicious things that are not compatible with one’s sensibilities.  
*Diet is important for sustaining physical and psychological health. Improper dietary habits can lead to various psychosomatic disorders associated with ''apasmara''.
+
*Diet is important for sustaining physical and psychological health. Improper dietary habits can lead to various psychosomatic disorders associated with apasmara.
*''Apasmara'' originates from the heart, which is the center of consciousness and emotions per Vedic texts. The clinical presentation includes impaired heart-brain coordination leading to transient loss of memory, erratic movements, and blackouts. Analysis of the heart-brain connection is very important in the pathology of ''apasmara''.  
+
*Apasmara originates from the heart, which is the center of consciousness and emotions per Vedic texts. The clinical presentation includes impaired heart-brain coordination leading to transient loss of memory, erratic movements, and blackouts. Analysis of the heart-brain connection is very important in the pathology of apasmara.  
*''Psychological'' stressors like excessive passion, anger, fear, greed, attachment, excitement, grief, anxiety, worry, perturbation etc. precipitate episodes of ''apasmara'' in a person afflicted with excessively aggravated ''dosha''.
+
*''Psychological'' stressors like excessive passion, anger, fear, greed, attachment, excitement, grief, anxiety, worry, perturbation etc. precipitate episodes of apasmara in a person afflicted with excessively aggravated ''[[dosha]]''.
*''Apasmara'', depending upon the predominant ''dosha'', can be diagnosed on the basis of frequency of episodes, duration of loss of consciousness, pattern of abnormal movements, and types of objects perceived (in aura phase) prior to the occurrence of an actual episode.  
+
*apasmara, depending upon the predominant ''[[dosha]]'', can be diagnosed on the basis of frequency of episodes, duration of loss of consciousness, pattern of abnormal movements, and types of objects perceived (in aura phase) prior to the occurrence of an actual episode.  
*Purification therapies using strong medicines, observing a healthy diet and lifestyle are considered the primary forms of treatment of ''apasmara''. Non-pharmacological measures like ''mantra'' (holy chants) and ''sattvavajaya chikitsa'' (mind training for restraint,  such as cognitive behavior therapy) aid in the treatment of ''apasmara''.  
+
*Purification therapies using strong medicines, observing a healthy diet and lifestyle are considered the primary forms of treatment of apasmara. Non-pharmacological measures like ''mantra'' (holy chants) and ''sattvavajaya chikitsa'' (mind training for restraint,  such as cognitive behavior therapy) aid in the treatment of apasmara.  
*One disease can cause other disease, therefore it is important to track the history of ailments to prescribe the most effective course (or courses) of treatment. 
 
 
*There can be one causative factor for many diseases or multiple causative factors for single disease.  
 
*There can be one causative factor for many diseases or multiple causative factors for single disease.  
 
*Similarly one symptom can be common in many diseases and one symptom can be seen in a single disease alone.  
 
*Similarly one symptom can be common in many diseases and one symptom can be seen in a single disease alone.  
 
*There could be a single treatment for many diseases or many treatments for a single disease.  
 
*There could be a single treatment for many diseases or many treatments for a single disease.  
 
*The duration of treatment depends upon prognosis of the disease. A disease at the onset may be curable but if not treated, could worsen into a palliable or incurable variant.   
 
*The duration of treatment depends upon prognosis of the disease. A disease at the onset may be curable but if not treated, could worsen into a palliable or incurable variant.   
*The subtle changes in ''dosha'', and the three states of a disease (aggravated, normal, or diminished) should be carefully observed along with proper assessment of body strength, digestive power and mental ability .  
+
*The subtle changes in ''[[dosha]]'', and the three states of a disease (aggravated, normal, or diminished) should be carefully observed along with proper assessment of body strength, digestive power and mental ability .  
*The ''doshas'' that spread obliquely (in the transverse direction) afflict patient for a longer time. These ''doshas'' should be managed first, or they should be carefully drawn to ''koshtha'' (bowel) by proper measures. After analyzing them in ''koshtha'', the physician should eliminate them through the nearest route.
+
*The ''[[dosha]]s'' that spread obliquely (in the transverse direction) afflict patient for a longer time. These ''[[dosha]]s'' should be managed first, or they should be carefully drawn to ''koshtha'' (bowel) by proper measures. After analyzing them in ''koshtha'', the physician should eliminate them through the nearest route.
  
=== ''Vidhi Vimarsha'' ===
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== Vidhi Vimarsha (Applied Inferences) ==
  
The chapter on ''apasmara'' is sequenced after the one on ''unmada''. The sequence is due to similarities of clinical origin as well as causative and pathophysiological factors, since both diseases are psychosomatic in nature.  
+
The chapter on apasmara is sequenced after the one on [[unmada]]. The sequence is due to similarities of clinical origin as well as causative and pathophysiological factors, since both diseases are psychosomatic in nature.  
  
==== History and origin of the disease in ancient medical literature ====
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=== History and origin of the disease in ancient medical literature ===
  
The origin of various diseases is narrated in the eleventh verse of the chapter. ''Apasmara'' originates from physical and mental contact with various unclean and unwholesome exogenous factors leading to imbalance at physical and psychological levels. The words ''ashuchi samsparsha'' literally mean direct contact of body and mind with unwholesome things. This is further supported by ''apasmara''’s etiology which points at improper diet and lifestyle as a major causative factor.  
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The origin of various diseases is narrated in the eleventh verse of the chapter. apasmara originates from physical and mental contact with various unclean and unwholesome exogenous factors leading to imbalance at physical and psychological levels. The words ''ashuchi samsparsha'' literally mean direct contact of body and mind with unwholesome things. This is further supported by apasmara’s etiology which points at improper diet and lifestyle as a major causative factor.  
 
    
 
    
 
Review of ancient medical literature confirms that epilepsy was initially called sacred, because of the belief for its divine origin<ref>Emmanouil Magiorkinis, Kalliopi Sidiropoulou Aristidis Diamantis. Hallmarks in the History of Epilepsy: From Antiquity Till the Twentieth Century. Novel Aspects on Epilepsy Office for the Study of History of Hellenic Naval Medicine, Naval Hospital of Athens, Greece.  </ref>. A chapter on epilepsy in Babylonian texts on medicine comprising 40 tablets dating as far back as 1067 BC accurately recorded many of the different seizure types recognized today. It emphasizes upon the supernatural nature of epilepsy, with each seizure type associated with a divinity, spirit or deity (usually evil)<ref> J. M. S. Pierce, a disease once sacred. A history of the medical understanding of epilepsy
 
Review of ancient medical literature confirms that epilepsy was initially called sacred, because of the belief for its divine origin<ref>Emmanouil Magiorkinis, Kalliopi Sidiropoulou Aristidis Diamantis. Hallmarks in the History of Epilepsy: From Antiquity Till the Twentieth Century. Novel Aspects on Epilepsy Office for the Study of History of Hellenic Naval Medicine, Naval Hospital of Athens, Greece.  </ref>. A chapter on epilepsy in Babylonian texts on medicine comprising 40 tablets dating as far back as 1067 BC accurately recorded many of the different seizure types recognized today. It emphasizes upon the supernatural nature of epilepsy, with each seizure type associated with a divinity, spirit or deity (usually evil)<ref> J. M. S. Pierce, a disease once sacred. A history of the medical understanding of epilepsy
 
By Mervyn J. Eadie and Peter F. Bladin2001. Eastleigh: John Libbey.  Pp. 248. ISBN 0‐86196‐607‐4. Oxford Journals Medicine Brain Volume 125, Issue 2 Pp. 441-442.
 
By Mervyn J. Eadie and Peter F. Bladin2001. Eastleigh: John Libbey.  Pp. 248. ISBN 0‐86196‐607‐4. Oxford Journals Medicine Brain Volume 125, Issue 2 Pp. 441-442.
  </ref>. It was believed, in antiquity, that if a person comes in contact with things that are supernatural and evil, he/she would suffer from epilepsy. This view is consistent with those in ancient Greek, British, and Indian (Vedic) literature as well. The Ayurvedic theory of origin of epilepsy mentions contact with evil, unwholesome and unclean objects or experiences as key causative factors. References of ''grahas'' (celestial bodies) as a causative factor of ''apasmara'', specifically in children, can be found in vedic texts with terms such as ‘skanda’ and ‘skandapasmara. Though there are references of exogenous variants of epilepsy (''agantu apasmara'') in [[Charaka Samhita]], a detailed description of these is not found. This indicates two things:  
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  </ref>. It was believed, in antiquity, that if a person comes in contact with things that are supernatural and evil, he/she would suffer from epilepsy. This view is consistent with those in ancient Greek, British, and Indian (Vedic) literature as well. The Ayurvedic theory of origin of epilepsy mentions contact with evil, unwholesome and unclean objects or experiences as key causative factors. References of ''grahas'' (celestial bodies) as a causative factor of apasmara, specifically in children, can be found in vedic texts with terms such as ‘skanda’ and ‘skandapasmara. Though there are references of exogenous variants of epilepsy (''agantu apasmara'') in [[Charak Samhita]], a detailed description of these is not found. This indicates two things:  
 
#Epilepsy originates from exposure to unwholesome, unclean and evil things either at a physical or at a psycho-spiritual plane.   
 
#Epilepsy originates from exposure to unwholesome, unclean and evil things either at a physical or at a psycho-spiritual plane.   
 
#Management of the disease may include ''adhyatmik chikitsa'' (psycho-spiritual therapy) for better treatment.
 
#Management of the disease may include ''adhyatmik chikitsa'' (psycho-spiritual therapy) for better treatment.
  
==== Definition of ''Apasmara'' ====
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=== Definition of apasmara ===
 +
 
 +
apasmara is defined as the occasional loss of consciousness due to deterioration of ''[[smriti]]'' (memory), ''[[buddhi]]'' (intellect) and ''sattva'' (mind), characterized by ''tamahpravesha'' (entering darkness/ blackouts) and ''bibhatsa cheshta'' (abnormal movements).
  
''Apasmara'' is defined as the occasional loss of consciousness due to deterioration of ''smriti'' (memory), ''buddhi'' (intellect) and ''sattva'' (mind), characterized by ''tamahpravesha'' (entering darkness/ blackouts) and ''bibhatsa cheshta'' (abnormal movements).  
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As explained by Sushruta, ''[[smriti]]'' in context of apasmara is ''bhutarha vijnana'' i.e. orientation of external world and consciousness. ''Dhi-buddhi'' (intellect) is ''karya-akarya vibhaga karini'' i.e. discriminating power between right and wrong. ''Sattva'' is referred as ''[[manas]]'' (mind) and ''dhairya'' (temperance, patience). A patient of apasmara suffers from deterioration of all these three important mental faculties (''dhi, [[buddhi]]'' and ''[[smriti]]'').  
  
As explained by Sushruta, ''smriti'' in context of apasmara is ''bhutarha vijnana'' i.e. orientation of external world and consciousness. ''Dhi-buddhi'' (intellect) is ''karya-akarya vibhaga karini'' i.e. discriminating power between right and wrong. ''Sattva'' is referred as ''mana'' (mind) and ''dhairya'' (temperance, patience). A patient of ''apasmara'' suffers from deterioration of all these three important mental faculties (''dhi, buddhi'' and ''smriti'').  
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The first cardinal sign of this deterioration is ''tamapravesha'' , i.e., ''jnana abhava'' or loss of knowledge and the ability to acquire new knowledge. The second cardinal sign,  ''bibhatsa cheshta'', indicates involuntary movements of body due to lack of brain’s control or improper coordination. Sushruta narrated that due to these features of apasmara, the disease often leads to death (''antakrita''). Dallhana comments that the dreadfulness of this disease is due to the fact that an afflicted person may fall into water or fire due to lack of orientation.
  
The first cardinal sign of this deterioration is ''tamapravesha'' , i.e., ''jnana abhava'' or loss of knowledge and the ability to acquire new knowledge. The second cardinal sign,  ''bibhatsa cheshta'',  indicates involuntary movements of body due to lack of brain’s control or improper coordination.  Sushruta narrated that due to these features of ''apasmara'', the disease often leads to death (''antakrita''). Dallhana comments that the dreadfulness of this disease is due to the fact that an afflicted person may fall into water or fire due to lack of orientation. 
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=== Impairment of knowledge and coordination ===
  
==== Impairment of knowledge and coordination ====
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  [[File:Co-ordination1.png|500px|'''Fig. 1: Faculty involved in attainment of knowledge'''|thumb]]
  [[File:Co-ordination1.png]]
 
Fig. 2: Faculty involved in attainment of knowledge  
 
  
According to Ayurveda, knowledge of external objects is processed through sense organs , to the mind- intellect, culminating in the spirit. This chain or sequence for attainment of knowledge is important for proper functioning of memory (encoding, storage and retrieval) and intellect (cognition) [Fig.2]. Occasional impairment of coordination in the sequence consisting of sense organs-intellect-mind-spirit is seen in apasmara. This may lead to decrease in cognitive performance of an individual.   
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According to [[Ayurveda]], knowledge of external objects is processed through sense organs , to the mind-intellect, culminating in the spirit. This chain or sequence for attainment of knowledge is important for proper functioning of memory (encoding, storage and retrieval) and intellect (cognition) [Fig.1]. Occasional impairment of coordination in the sequence consisting of sense organs-intellect-mind-spirit is seen in apasmara. This may lead to decrease in cognitive performance of an individual.[Fig. 1: Faculty involved in attainment of knowledge]    
  
In conventional medicine, three major factors that cause disturbance in cerebral neurotransmission leading to blackouts and epilepsy viz. hypo-perfusion, hypo-metabolism, and hypoxia have been described in relevant medical texts. These disturbances lead to abnormal discharges, improper signal transduction in the neurotransmitter channels, and seizures. As a consequence, cellular dysfunctions in the brain, disruptions of the memory mechanism, and disturbed coordination of movements may occur causing the clinical manifestation of ''apasmara''. The role of these three factors and its impact on memory and cellular dysfunction in the pathogenesis of epilepsy need to be elucidated. The three pathological effects are comparable to the changes created by vitiation of ''kapha, pitta'' and ''vata''. Differentiation between these three types of manifestations is described further.  
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In conventional medicine, three major factors that cause disturbance in cerebral neurotransmission leading to blackouts and epilepsy viz. hypo-perfusion, hypo-metabolism, and hypoxia have been described in relevant medical texts. These disturbances lead to abnormal discharges, improper signal transduction in the neurotransmitter channels, and seizures. As a consequence, cellular dysfunctions in the brain, disruptions of the memory mechanism, and disturbed coordination of movements may occur causing the clinical manifestation of apasmara. The role of these three factors and its impact on memory and cellular dysfunction in the pathogenesis of epilepsy need to be elucidated. The three pathological effects are comparable to the changes created by vitiation of ''[[kapha]], [[pitta]]'' and ''[[vata]]''. Differentiation between these three types of manifestations is described further.  
  
Per Ayurveda, ''smriti'' is ''atmaja'' (originated from the soul) and ''sattvaja'' (originated from the mind). This means that ''smriti'' (memory) of a person is essentially related with soul and mind. The Bhagavad Gita describes the consequences of excessive indulgence in sensory activities leading to excessive affliction resulting in an increase in passion, then anger, and then lack of knowledge. This further leads to deterioration of ''smriti'' and then affecting the intellect. This sequence lays the ground for ''apasmara''.
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Per [[Ayurveda]], ''[[smriti]]'' is ''atmaja'' (originated from the soul) and ''sattvaja'' (originated from the mind). This means that ''[[smriti]]'' (memory) of a person is essentially related with soul and mind. The Bhagavad Gita describes the consequences of excessive indulgence in sensory activities leading to excessive affliction resulting in an increase in passion, then anger, and then lack of knowledge. This further leads to deterioration of ''[[smriti]]'' and then affecting the intellect. This sequence lays the ground for apasmara.
  
==== ''Tattva Sara'' ====
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=== ''Tattva Sara'' ===
  
Three factors of mind, memory, intellect and consciousness are impaired in ''apasmara''. Due care should be taken to protect and manage these three. Herbs like ''medhya rasayana'' and treatment modalities like ''sattvajaya chikitsa'' are known to promote activities of mind, intellect and consciousness.  
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Three factors of mind, memory, intellect and consciousness are impaired in apasmara. Due care should be taken to protect and manage these three. Herbs like ''medhya [[rasayana]]'' and treatment modalities like ''sattvajaya chikitsa'' are known to promote activities of mind, intellect and consciousness.
  
==== Predisposing factors for ''apasmara'' ====
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=== Predisposing factors for apasmara ===
  
 
The susceptible individuals and conditions for epilepsy are described in detail:
 
The susceptible individuals and conditions for epilepsy are described in detail:
  
===== ''Rajas–tamas'' affliction =====
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==== ''Rajas–tamas'' affliction ====
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The first factor, ''rajas - tamas'' affliction, signifies the role of mind in etio-pathology of apasmara. ''Rajas'' is a ''[[guna]]'' (tendency or attribute) responsible for the initiation of every kind of activity and symbolizes energy, while ''Tamas'' is the ''[[guna]]'' symbolizing inertia, dulling or stopping of activities. These two play an important role in the coordination of activities within the sequence of sense organs-mind-intellect-spirit, in the attainment of knowledge as well as to maintain the orientation of external world (consciousness). A ''rajas-tamas'' affliction, therefore, adversely impacts coordination of activities and perverts the mind and intellect, landing the patient into loss of orientation and consciousness. A “distressed” state of mind, caused by ''rajas-tamas'' affliction, is an important etiological factor responsible for various psychosomatic disorders such as epilepsy. Therefore, rehabilitating the ''rajas - tamas'' balance (and thus, achieving harmony between all the three ''[[guna]]s'') is of utmost importance in preventing the pathology and maintenance of health. Neurologically, initiation of action through neurotransmitters such as acetylcholine, while inhibition of action through dopamine can be categorized under ''rajas'' and ''tamas'' respectively. Synchronization of discharges in the cerebral region is a result of ''rajas-tamas'' balance. Disturbance in this ''rajas-tamas'' balance and depletion of ''sattva'' leads to hypersynchronization, resulting in seizures. Threshold of neuronal activity is due to balance between ''sattva, rajas'' and ''tamas''. It is ''sattva'' that maintains the normal threshold of neuronal activities. Decreased ''sattva'' and/or increased ''rajas'' and ''tamas'' can alter the threshold of neurons.
  
The first factor, ''rajas - tamas'' affliction, signifies the role of mind in etio-pathology of ''apasmara''. ''Rajas'' is a ''guna'' (tendency or attribute) responsible for the initiation of every kind of activity and symbolizes energy, while ''Tamas'' is the ''guna'' symbolizing inertia, dulling or stopping of activities. These two play an important role in the coordination of activities within the sequence of sense organs-mind-intellect-spirit, in the attainment of knowledge as well as to maintain the orientation of external world (consciousness). A ''rajas-tamas'' affliction, therefore, adversely impacts coordination of activities and perverts the mind and intellect, landing the patient into loss of orientation and consciousness. A “distressed” state of mind, caused by ''rajas-tamas'' affliction, is an important etiological factor responsible for various psychosomatic disorders such as epilepsy. Therefore, rehabilitating the ''rajas - tamas'' balance (and thus, achieving harmony between all the three ''gunas'') is of utmost importance in preventing the pathology and maintenance of health. Neurologically, initiation of action through neurotransmitters such as acetylcholine, while inhibition of action through dopamine can be categorized under ''rajas'' and ''tamas'' respectively. Synchronization of discharges in the cerebral region is a result of ''rajas-tamas'' balance. Disturbance in this ''rajas-tamas'' balance and depletion of ''sattva'' leads to hypersynchronization, resulting in seizures. Threshold of neuronal activity is due to balance between ''sattva, rajas'' and ''tamas''. It is ''sattva'' that maintains the normal threshold of neuronal activities. Decreased ''sattva'' and/or increased ''rajas'' and ''tamas'' can alter the threshold of neurons.  
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The state of mind afflicted due to ''rajas'' and ''tamas'' can be considered as ‘distressed mind’ observed as important causative factor for various psycho somatic disorders like epilepsy.
  
The state of mind afflicted due to ''rajas'' and ''tamas'' can be considered as ‘distressed mind’ observed as important causative factor for various psycho somatic disorders like epilepsy.
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==== ''Sharira dosha'' vitiation ====
       
 
===== ''Sharira dosha'' vitiation =====
 
  
The second important factor is imbalance of ''doshas'' at the somatic level. There are three terms used to indicate the state of ''doshas'' which predisposes ''apasmara'':
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The second important factor is imbalance of ''doshas'' at the somatic level. There are three terms used to indicate the state of ''[[dosha]]s'' which predisposes apasmara:
*First is ''udbhranta'' (moving upwards in vitiated state). The upward direction of flow of ''doshas'' may indicate the pathway of ''apasmara'' from the heart to the brain. The pathology starts from the abode of consciousness i.e. heart, spreading upwards afflicting sense organs. In [[Chikitsa Sthana]], the term ''vibhranta'' is used to denote this condition.  
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*First is ''udbhranta'' (moving upwards in vitiated state). The upward direction of flow of ''[[dosha]]s'' may indicate the pathway of apasmara from the heart to the brain. The pathology starts from the abode of consciousness i.e. heart, spreading upwards afflicting sense organs. In [[Chikitsa Sthana]], the term ''vibhranta'' is used to denote this condition.  
*The second state is ''vishama'', meaning a state of disequilibrium. Imbalanced ''doshas'' create a favorable environment for ''apasmara''. *The third state is ''bahu'' (excessive), meaning that the imbalance is excessive enough to affect the brain-mind system. This suggests that the ''doshas'' are in an aggravated state of imbalance and predispose to the disease. The condition also points towards manifestation of ''apasmara'' as a result of other somatic disease pathologies.
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*The second state is ''vishama'', meaning a state of disequilibrium. Imbalanced ''[[dosha]]s'' create a favorable environment for apasmara. *The third state is ''bahu'' (excessive), meaning that the imbalance is excessive enough to affect the brain-mind system. This suggests that the ''[[dosha]]s'' are in an aggravated state of imbalance and predispose to the disease. The condition also points towards manifestation of apasmara as a result of other somatic disease pathologies.
  
The disease condition is a result of combination of the above states of ''doshas'' with the ''rajas-tamas'' affliction. These are ''sanchaya'' (accumulation), ''prakopa'' (aggravation) and ''prasara'' (spread) stages of the disease - important somatic factors for causation of ''apasmara''.
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The disease condition is a result of combination of the above states of ''[[dosha]]s'' with the ''rajas-tamas'' affliction. These are ''sanchaya'' (accumulation), ''prakopa'' (aggravation) and ''prasara'' (spread) stages of the disease - important somatic factors for causation of apasmara.
  
The cumulative presentation suggests the psychosomatic nature of the disease where the psyche and soma are equally involved in the pathogenesis. This is important while treating ''apasmara'', because this indicates that only administering anti-epileptic drugs is not enough in treating ''apasmara''. The treatment of underlying psychological factors shall also be given due emphasis.
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The cumulative presentation suggests the psychosomatic nature of the disease where the psyche and soma are equally involved in the pathogenesis. This is important while treating apasmara, because this indicates that only administering anti-epileptic drugs is not enough in treating apasmara. The treatment of underlying psychological factors shall also be given due emphasis.
  
===== Role of diet =====
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==== Role of diet ====
  
The third key factor is the role of quality of diet in the causation of the disease. Charaka uses terms like ''samala'' (impure), ''vikrita'' (deformed/altered), ''upahita'' (mixed), and ''ashuchi'' (unclean/unhygienic) as adjectives to describe food articles that cause ''apasmara''. Sushruta uses terms like ''viruddha'' (incompatible or of contradictory/antagonistic nature) and ''malina'' (bad) for the same factors. Besides providing nutrition to the body, diet plays a great impact on the mind as well. It is mentioned in the texts that the nutrition of soma and psyche occurs through food and food habits. Yogic texts narrate the role of food in nourishing five sheaths of the body, called ''annamaya kosha, pranamaya kosha, vijnanamaya kosha, manomaya kosha'' and ''anandmaya kosha''. Therefore, diet is not only important for proper functioning of the three ''doshas'', but also for nourishment of the mind and the soul. Charaka as well as Sushruta have acknowledged the role of unclean, unhygienic, unwholesome, incompatible diet in the causation of ''apasmara''. Dallhana commented that this includes the diet that is ''dwishta'' (disliked by mind or taken with hatred feeling), ''amedhya'' (not satisfying mind) and ''paryushita'' (stale). All these types of diet can cause disturbance in the body and mind. As per conventional medicine, a diet that is deficient in certain vitamins and minerals and that which increases neurotoxins may lead to neurological disorders. Therefore, biochemical changes in the above mentioned causative foods may lead to deficiencies of important nutrients and cause increase in neurotoxins resulting in ''apasmara'' like disorders. Moreover, some gastrointestinal symptoms have been described further as premonitory symptoms of ''apasmara''. The role of diet and food habits as a cause of ''apasmara'' needs to be further researched. These factors are to be avoided during the treatment of apasmara. Not following /proper dietary rules is one of the key causes for the formation of ''ama''. ''Ama'' produces free radicals leading to excessive oxidative stress and tissue injuries. Therefore, following proper dietary habits is important in preventing the pathogenesis of the disease. Furthermore, this suggests the possibility of food contamination as a causative factor for epilepsy. A case of endrin-laced taquitos causing seizures in the US is an example of food contamination causing epileptic seizures .<ref> K Waller, T J Prendergast, A Slagle, R J Jackson.Seizures after eating a snack food contaminated with the pesticide endrin. The tale of the toxic taquitos. West J Med. 1992 Dec; 157(6): 648–651 </ref>
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The third key factor is the role of quality of diet in the causation of the disease. Charak uses terms like ''samala'' (impure), ''vikrita'' (deformed/altered), ''upahita'' (mixed), and ''ashuchi'' (unclean/unhygienic) as adjectives to describe food articles that cause apasmara. Sushruta uses terms like ''viruddha'' (incompatible or of contradictory/antagonistic nature) and ''malina'' (bad) for the same factors. Besides providing nutrition to the body, diet plays a great impact on the mind as well. It is mentioned in the texts that the nutrition of soma and psyche occurs through food and food habits. Yogic texts narrate the role of food in nourishing five sheaths of the body, called ''annamaya kosha, pranamaya kosha, vijnanamaya kosha, manomaya kosha'' and ''anandmaya kosha''. Therefore, diet is not only important for proper functioning of the three ''[[dosha]]s'', but also for nourishment of the mind and the soul. Charak as well as Sushruta have acknowledged the role of unclean, unhygienic, unwholesome, incompatible diet in the causation of apasmara. Dallhana commented that this includes the diet that is ''dwishta'' (disliked by mind or taken with hatred feeling), ''amedhya'' (not satisfying mind) and ''paryushita'' (stale). All these types of diet can cause disturbance in the body and mind. As per conventional medicine, a diet that is deficient in certain vitamins and minerals and that which increases neurotoxins may lead to neurological disorders. Therefore, biochemical changes in the above mentioned causative foods may lead to deficiencies of important nutrients and cause increase in neurotoxins resulting in apasmara like disorders. Moreover, some gastrointestinal symptoms have been described further as premonitory symptoms of apasmara. The role of diet and food habits as a cause of apasmara needs to be further researched. These factors are to be avoided during the treatment of apasmara. Not following /proper dietary rules is one of the key causes for the formation of ''ama''. ''Ama'' produces free radicals leading to excessive oxidative stress and tissue injuries. Therefore, following proper dietary habits is important in preventing the pathogenesis of the disease. Furthermore, this suggests the possibility of food contamination as a causative factor for epilepsy. A case of endrin-laced taquitos causing seizures in the US is an example of food contamination causing epileptic seizures .<ref> K Waller, T J Prendergast, A Slagle, R J Jackson.Seizures after eating a snack food contaminated with the pesticide endrin. The tale of the toxic taquitos. West J Med. 1992 Dec; 157(6): 648–651 </ref>
  
===== Improper methods – lifestyle factors =====
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==== Improper methods – lifestyle factors ====
 
    
 
    
The fourth etiological factor of epilepsy is not following the prescribed rules of diet and lifestyle. The ''upayoga vidhi'' lists improper dietary habits, lifestyle and code of conduct that lead to disturbances in soma and psyche. Sushruta has elaborated the role of incorrect or excessive indulgence in activities of sense organs and locomotor organs as the foremost causative factor for ''apasmara''. This is suggestive of disturbances in the knowledge coordination chain leading to lack of attainment of knowledge. This factor also indicates role of unhealthy regimens and behavior in patho-physiology of epilepsy. The factor underlies ignorance towards proper ''dinacharya'' (diurnal regimen), ''ratricharya'' (night regimen) and ''ritucharya'' (seasonal regimen). The lifestyle and behavior of a person is important for achieving normalcy in the psychic plane and for avoiding psychological disorders. This also suggests the inclusion of ''prajnaparadha'' (intellectual blasphemy) described in [[Sharira Sthana]]. ''Achara rasayana'' (code of conduct) should be followed as a therapeutic regimen in the management of ''apasmara''. The psycho-neuro-biological basis of etiopathological factors causing neurological disorders is being extensively researched with positive outcomes. Psycho-social distress is an important underlying factor for such disorders through impairment of hypothalamo-pituitary-adrenal axis. The preventive measures to be included are correct and productive indulgence in the sensory and locomotor activities as per capacity of an individual. Psychotherapy is believed to be effective in the management of ''apasmara''.    
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The fourth etiological factor of epilepsy is not following the prescribed rules of diet and lifestyle. The ''upayoga vidhi'' lists improper dietary habits, lifestyle and code of conduct that lead to disturbances in soma and psyche. Sushruta has elaborated the role of incorrect or excessive indulgence in activities of sense organs and locomotor organs as the foremost causative factor for apasmara. This is suggestive of disturbances in the knowledge coordination chain leading to lack of attainment of knowledge. This factor also indicates role of unhealthy regimens and behavior in patho-physiology of epilepsy. The factor underlies ignorance towards proper ''[[dinacharya]]'' (diurnal regimen), ''ratricharya'' (night regimen) and ''ritucharya'' (seasonal regimen). The lifestyle and behavior of a person is important for achieving normalcy in the psychic plane and for avoiding psychological disorders. This also suggests the inclusion of ''prajnaparadha'' (intellectual blasphemy) described in [[Sharira Sthana]]. ''Achara rasayana'' (code of conduct) should be followed as a therapeutic regimen in the management of apasmara. The psycho-neuro-biological basis of etiopathological factors causing neurological disorders is being extensively researched with positive outcomes. Psycho-social distress is an important underlying factor for such disorders through impairment of hypothalamo-pituitary-adrenal axis. The preventive measures to be included are correct and productive indulgence in the sensory and locomotor activities as per capacity of an individual. Psychotherapy is believed to be effective in the management of apasmara.
  
===== Improper techniques =====
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==== Improper techniques ====
  
Observance of improper ''tantra'' (techniques/methods) makes the person prone to ''apasmara'' and is the fifth causative factor. This includes iatrogenic factors such as improper follow ups of [[Panchakarma]] procedures leading to vitiation of ''doshas'' in the body. The other meaning of ''tantra'' might be related to spiritual practices that are related to the supernatural powers mentioned earlier as reasons for causing epilepsy. Improper use of these tantric therapies can result in epilepsy.
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Observance of improper ''tantra'' (techniques/methods) makes the person prone to apasmara and is the fifth causative factor. This includes iatrogenic factors such as improper follow ups of [[Panchakarma]] procedures leading to vitiation of ''[[dosha]]s'' in the body. The other meaning of ''tantra'' might be related to spiritual practices that are related to the supernatural powers mentioned earlier as reasons for causing epilepsy. Improper use of these tantric therapies can result in epilepsy.
  
Iatrogenic causes can increase susceptibility to ''apasmara''. Therefore all procedures should be followed properly in order to prevent complications.
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Iatrogenic causes can increase susceptibility to apasmara. Therefore all procedures should be followed properly in order to prevent complications.
  
===== Incorrect postures and movements =====
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==== Incorrect postures and movements ====
  
The sixth etiological factor constitutes of wrong postures and movements. Since the coordination of movements is regulated by ''dhi-buddhi-smriti'', any imbalance in the sense organs-mind-intellect-spirits sequence not only impairs movement of limbs but also increases the propensity of getting afflicted with ''apasmara''. Conversely, wrong postures and movements are a result of disturbances in the sense organs-spirits sequence that lead to incorrect attainment of knowledge with the manifestation of ''apasmara''.
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The sixth etiological factor constitutes of wrong postures and movements. Since the coordination of movements is regulated by ''dhi-[[buddhi]]-[[smriti]]'', any imbalance in the sense organs-mind-intellect-spirits sequence not only impairs movement of limbs but also increases the propensity of getting afflicted with apasmara. Conversely, wrong postures and movements are a result of disturbances in the sense organs-spirits sequence that lead to incorrect attainment of knowledge with the manifestation of apasmara.
  
Uncomfortable sitting, sleeping, positioning, irregular, uncoordinated movements of body (e.g. improper dance, sports etc.) can predispose ''apasmara''.
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Uncomfortable sitting, sleeping, positioning, irregular, uncoordinated movements of body (e.g. improper dance, sports etc.) can predispose apasmara.
  
===== Excessive degeneration and debility =====
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==== Excessive degeneration and debility ====
  
The seventh and last etiological factor i.e. excessive degeneration or debility may lead to pathogenesis of ''apasmara'' , pointing at ''dhatukshayajanya vataprakopa'' (vitiation of ''vata'' due to depletion of tissues) as a root cause. The degeneration might be a secondary condition resulting from other diseases. Hypo-perfusion and low levels of oxygen and metabolism could result in brain cell dysfunctions causing seizures. This is analogous to the concept of ''ati upakshaya'' in Ayurveda. Therefore, a clinical examination of depletion of tissues (''dhatukshaya'') could be considered as a treatment component in the management of ''apasmara''.
+
The seventh and last etiological factor i.e. excessive degeneration or debility may lead to pathogenesis of apasmara , pointing at ''dhatukshayajanya vataprakopa'' (vitiation of ''[[vata]]'' due to depletion of tissues) as a root cause. The degeneration might be a secondary condition resulting from other diseases. Hypo-perfusion and low levels of oxygen and metabolism could result in brain cell dysfunctions causing seizures. This is analogous to the concept of ''ati upakshaya'' in [[Ayurveda]]. Therefore, a clinical examination of depletion of tissues (''dhatukshaya'') could be considered as a treatment component in the management of apasmara.
  
 
Acute and severe electrolyte imbalances (hyponatremia, hypocacemia and hypomagnesemia) frequently cause seizures.
 
Acute and severe electrolyte imbalances (hyponatremia, hypocacemia and hypomagnesemia) frequently cause seizures.
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The underlying etiology of other degenerative diseases should be considered while dealing with cases of epilepsy. In that case, management of epilepsy should be supported by proper nutrition, restorative, replenishing and rejuvenation therapies.
 
The underlying etiology of other degenerative diseases should be considered while dealing with cases of epilepsy. In that case, management of epilepsy should be supported by proper nutrition, restorative, replenishing and rejuvenation therapies.
  
===== Additional factors by Sushruta =====
+
==== Additional factors by Sushruta ====
  
In addition to the above factors, Sushruta has quoted two more factors for predisposition of ''apasmara''. ''Veganigraha sheelanam'' i.e. habitual suppression of natural urges and ''gachchatam cha rajaswalam'' i.e., having sexual intercourse with menstruating women can make the individual more susceptible to epilepsy. Recent research suggests that menotoxins secreted by the female body during menstruation significantly impact the psyche of a person accompanying that female.  
+
In addition to the above factors, Sushruta has quoted two more factors for predisposition of apasmara. ''Veganigraha sheelanam'' i.e. habitual suppression of natural urges and ''gachchatam cha rajaswalam'' i.e., having sexual intercourse with menstruating women can make the individual more susceptible to epilepsy. Recent research suggests that menotoxins secreted by the female body during menstruation significantly impact the psyche of a person accompanying that female.  
  
On the first of these two factors, per Ayurveda, suppression of any of the thirteen types of natural urges may lead to various disorders. Suppressing natural urges leads to ''vata''-dominant disorders and as ''vata'' is the regulator of mind-related activities, this consequently can result in neuropsychiatric disorders like ''apasmara''. All the urges are stimulated, regulated and completed by the nervous system. Inhibition of these factors might lead to impairment of neurotransmission which can be a cause for neuropsychiatric disorders. Furthermore, suppression of urges can lead to accumulation of waste materials inside the body creating various diseases.  
+
On the first of these two factors, per [[Ayurveda]], suppression of any of the thirteen types of natural urges may lead to various disorders. Suppressing natural urges leads to ''[[vata]]''-dominant disorders and as ''[[vata]]'' is the regulator of mind-related activities, this consequently can result in neuropsychiatric disorders like apasmara. All the urges are stimulated, regulated and completed by the nervous system. Inhibition of these factors might lead to impairment of neurotransmission which can be a cause for neuropsychiatric disorders. Furthermore, suppression of urges can lead to accumulation of waste materials inside the body creating various diseases.  
  
On the second factor mentioned here, the correlation between having an intercourse with menstruating woman and getting afflicted with epilepsy needs to be researched further. Ayurveda strictly forbids sharing things with a menstruating woman, leave aside touching or having sexual relations with one. While there are reasons of following sacredness associated with this, sex with a menstruating woman is also indicative of exposure to unclean objects described earlier as the origin of ''apasmara''. The psycho-neuro-endocrinological axis behind this view of Sushruta needs to be explored.   
+
On the second factor mentioned here, the correlation between having an intercourse with menstruating women and getting afflicted with epilepsy needs to be researched further. [[Ayurveda]] strictly forbids sharing things with a menstruating woman, leave aside touching or having sexual relations with one. While there are reasons of following sacredness associated with this, sex with a menstruating woman is also indicative of exposure to unclean objects described earlier as the origin of apasmara. The psycho-neuro-endocrinological axis behind this view of Sushruta needs to be explored.   
 
      
 
      
Thus, from the above descriptions, etiopathological factors of ''apasmara'' can be categorized into dietary factors, lifestyle factors, psychological factors, behavioral factors and iatrogenic factors. All the above predisposing factors can be scanned for epigenetic modifications with respect to personality types, behavior patterns and occurrence of ''apasmara'' in such cases. This will be useful in identifying the disease at a primitive stage, breaking the pathogenesis at an intermedial stage and prevention of further deterioration and complications at later stage. There might be certain epigenetic patterns/changes due to the above mentioned etiological factors, which make the person more susceptible to get affected.  
+
Thus, from the above descriptions, etiopathological factors of apasmara can be categorized into dietary factors, lifestyle factors, psychological factors, behavioral factors and iatrogenic factors. All the above predisposing factors can be scanned for epigenetic modifications with respect to personality types, behavior patterns and occurrence of apasmara in such cases. This will be useful in identifying the disease at a primitive stage, breaking the pathogenesis at an intermedial stage and prevention of further deterioration and complications at later stage. There might be certain epigenetic patterns/changes due to the above mentioned etiological factors, which make the person more susceptible to get affected.  
  
The above enlisted etiological factors cause depletion in psychological strength (objectively measured as Intelligence quotient (IQ) and Emotional Quotient (EQ). In the era of distress, it is important to know the etiology of a disease in order to prevent its harmful effects. In order to preserve and increase the psychological strength, one shall avoid the causative factors for ''apasmara''.
+
The above enlisted etiological factors cause depletion in psychological strength (objectively measured as Intelligence quotient (IQ) and Emotional Quotient (EQ). In the era of distress, it is important to know the etiology of a disease in order to prevent its harmful effects. In order to preserve and increase the psychological strength, one shall avoid the causative factors for apasmara.
 
</div>
 
</div>
  
[[File:psycho-dynamics.png]]<br>
+
[[File:psycho-dynamics.png|500px|'''Fig.2: Psycho-dynamics in Apasmara'''|thumb ]]<br>
Fig.3: Psycho-dynamics in Apasmara
+
'''Fig.2: Psycho-dynamics in apasmara'''
 
 
 
 
  
[[File:pathogenesis.png]]
+
=== Six stages of pathogenesis of epilepsy (''shatkriyakala'' for apasmara) ===
 +
The pathogenesis of apasamara can be understood as below. [Fig.3: Schematic presentation of pathogenesis of apasmara]
  
 +
[[File:pathogenesis.png|500px|'''Fig.3a: Schematic presentation of pathogenesis of apasmara'''|thumb]]
  
 +
[[File:pathogenesis part2.png|500px|'''Fig.3b: Schematic presentation of pathogenesis of apasmara'''| thumb]]<br>
  
[[File:pathogenesis part2.png]]<br>
+
==== ''Sanchaya'' ====
Fig.4: Satic presentation of pathogenesis of Apasmara
 
 
 
==== Six stages of pathogenesis of epilepsy (''shatkriyakala'' for ''apasmara'') ====
 
 
===== ''Sanchaya'' =====
 
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
The first stage of accumulation of pathogenic factors (vitiated ''doshas'') starts at their own sites. It is initiated right from the first exposure to unclean objects and other etiological factors mentioned earlier. This stage is characterized by mild disturbances in the psyche (''rajas'' and ''tamas'') and soma (''tridosha'').
+
The first stage of accumulation of pathogenic factors (vitiated ''[[dosha]]s'') starts at their own sites. It is initiated right from the first exposure to unclean objects and other etiological factors mentioned earlier. This stage is characterized by mild disturbances in the psyche (''rajas'' and ''tamas'') and soma (''tri[[dosha]]'').
  
===== ''Prakopa'' =====
+
==== ''Prakopa'' ====
  
If the individual excessively indulges in observing causative factors for a significant period, then the ''doshas'' proceed to the next stage of pathology i.e. ''prakopa''. The ''doshas'' are vitiated at their own site. In case of ''apasmara'', the doshas reside at the vessels, above the heart (the site of consciousness) in a leena (dormant) state.<ref> Agnivesha ,’Charaka Samhita’, revised by Charaka and Dridhbala with  ‘Ayurveda Dipika’ commentary, by Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, Krishnadas Academy, Varanasi. reprint 2000. Chakrapani commentary Apasmara chikitsa 10/6.pg.475 </ref>
+
If the individual excessively indulges in observing causative factors for a significant period, then the ''[[dosha]]s'' proceed to the next stage of pathology i.e. ''prakopa''. The ''[[dosha]]s'' are vitiated at their own site. In case of apasmara, the doshas reside at the vessels, above the heart (the site of consciousness) in a leena (dormant) state [Cha.Sa.[[Chikitsa Sthana]] 10/6].
  
===== ''Prasara'' =====
+
==== ''Prasara'' ====
  
Whenever the provocative emotional factors like worries, passion, anger etc. trigger these ''doshas'', the vitiated ''dosha'' moves upwards affecting the sense and locomotor organs. This will present the ''prasara avastha'' (stage of spread) of the disease.  
+
Whenever the provocative emotional factors like worries, passion, anger etc. trigger these ''[[dosha]]s'', the vitiated ''[[dosha]]'' moves upwards affecting the sense and locomotor organs. This will present the ''prasara avastha'' (stage of spread) of the disease.  
  
===== ''Sthanasamshraya'' =====
+
==== ''Sthanasamshraya'' ====
  
Thereafter in ''sthanasamshraya avastha'' of ''apasmara'' (change in stage, triggering premonitory signs and symptoms), the stridden ''doshas'' take pathways of sense organs and locomotor organs alerting manifestation of the disease. This is called the aura stage of epilepsy.  
+
Thereafter in ''sthanasamshraya avastha'' of apasmara (change in stage, triggering premonitory signs and symptoms), the stridden ''[[dosha]]s'' take pathways of sense organs and locomotor organs alerting manifestation of the disease. This is called the aura stage of epilepsy.  
  
===== ''Vyakta'' =====
+
==== ''Vyakta'' ====
  
Then, the ''vyakta'' i.e. manifestation stage of ''apasmara'' is apparent due to excessive aggravation of ''doshas''. The severity of paroxysms depends upon ''sharira bala'' (physical strength that helps do physical work as well as prevent manifestations of diseases, includes genetic predisposition as well), ''hetu'' (strength of causative agents depending upon their exposure) and ''sattva bala'' (strength of mind). The clinical manifestation will be a product of interactions between these factors. Common clinical features of the disease will start showing at this stage.  
+
Then, the ''vyakta'' i.e. manifestation stage of apasmara is apparent due to excessive aggravation of ''[[dosha]]s''. The severity of paroxysms depends upon ''sharira bala'' (physical strength that helps do physical work as well as prevent manifestations of diseases, includes genetic predisposition as well), ''hetu'' (strength of causative agents depending upon their exposure) and ''sattva bala'' (strength of mind). The clinical manifestation will be a product of interactions between these factors. Common clinical features of the disease will start showing at this stage.  
  
===== ''Bheda avastha'' =====
+
==== ''Bheda avastha'' ====
  
''Bheda avastha'' is the stage of differentiation depending upon the dominance of ''doshas''. This will predominantly depend upon the genetic constitution of the person as well as the intake of alleviators and pacifiers of that particular ''dosha''. If there are some pacification factors in between, then the progression of disease stops at that stage only blocking presentation of clinical features.     
+
''Bheda avastha'' is the stage of differentiation depending upon the dominance of ''[[dosha]]s''. This will predominantly depend upon the genetic constitution of the person as well as the intake of alleviators and pacifiers of that particular ''[[dosha]]''. If there are some pacification factors in between, then the progression of disease stops at that stage only blocking presentation of clinical features.     
If we critically analyze and compare the pathophysiology, it can be observed that unlike modern research, the brain did not figure in Charaka’s analysis of disease or their pathologic basis, nor did he emphasize the role of an exogenous or supernatural power (''agantuka'') factor in the causation of epilepsy. Charaka has clearly mentioned heart, the abode of self and consciousness, as the origin for ''apasmara''. In the seizure state, ''doshas'' stride upwards through ''dhamanis'' (vessels), affecting the ''indriyas'' (sense and locomotor organs) leading to erratic movements and loss of consciousness. Sushruta and Vagbhata have specifically mentioned the ''samajnavahishu srotasu'' (channels of consciousness) as the pathway of spread of ''doshas'' and as a site for the disease.     
+
If we critically analyze and compare the pathophysiology, it can be observed that unlike modern research, the brain did not figure in Charak’s analysis of disease or their pathologic basis, nor did he emphasize the role of an exogenous or supernatural power (''agantuka'') factor in the causation of epilepsy. Charak has clearly mentioned heart, the abode of self and consciousness, as the origin for apasmara. In the seizure state, ''[[dosha]]s'' stride upwards through ''dhamanis'' (vessels), affecting the ''[[indriya]]s'' (sense and locomotor organs) leading to erratic movements and loss of consciousness. Sushruta and Vagbhata have specifically mentioned the ''samajnavahishu srotasu'' (channels of consciousness) as the pathway of spread of ''[[dosha]]s'' and as a site for the disease.     
  
As per Ayurveda, the heart (and not the brain), is the locus or abode of the mind, consciousness and soul , and emotional factors are considered as some of the root causes for triggering epilepsy. The clinical presentation of epilepsy represents the derangement of functions of neurons of central nervous system, but the origin of this derangement shall have been predisposed much earlier due to psycho-pathological factors enlisted above. The acute onset of seizure can be precipitated due to emotional factors. The mechanism of this phenomenon and exact psycho-neuronal pathways behind this are worthy of study.   
+
As per [[Ayurveda]], the heart (and not the brain), is the locus or abode of the mind, consciousness and soul , and emotional factors are considered as some of the root causes for triggering epilepsy. The clinical presentation of epilepsy represents the derangement of functions of neurons of central nervous system, but the origin of this derangement shall have been predisposed much earlier due to psycho-pathological factors enlisted above. The acute onset of seizure can be precipitated due to emotional factors. The mechanism of this phenomenon and exact psycho-neuronal pathways behind this are worthy of study.   
  
 
''Prana vayu'' (''buddhi-hridaya-indriya-chitta dhruk'', i.e., regulation of intellect, heart, senses, mind functions), ''vyana vayu'' (seat at ''hridaya'' and regulating all types of movements), ''udana vayu'' (functions for energy and activities), ''sadhaka pitta'' (type of ''pitta dosha''), ''tarpaka'' (type of ''kapha'') and ''avalambaka kapha'' (type of ''kapha'') are important to be considered as patho-physiological factors in this context.
 
''Prana vayu'' (''buddhi-hridaya-indriya-chitta dhruk'', i.e., regulation of intellect, heart, senses, mind functions), ''vyana vayu'' (seat at ''hridaya'' and regulating all types of movements), ''udana vayu'' (functions for energy and activities), ''sadhaka pitta'' (type of ''pitta dosha''), ''tarpaka'' (type of ''kapha'') and ''avalambaka kapha'' (type of ''kapha'') are important to be considered as patho-physiological factors in this context.
  
==== Types of ''Apasmara'' ====
+
=== Types of apasmara ===
  
There are four types of ''apasmara'' depending upon the predominance of ''dosha'' as shown in fig. 5. The first thing of significance is that all these are ''sharira doshas'' and not ''manasa doshas''. This implies that apasmara is predominantly a somatic disease in which psychological factors play a role in pathogenesis. The important aspect of management should be focused at the somatic level supported by psychotherapy. The role of genetic constitution is important in the study of clinical manifestations of ''apasmara'' as well as their response either to treatments involving allopathic anti-epileptic medications or to Ayurvedic treatment modalities. The diagnosis of dominance of ''dosha'' is also important in deciding the treatment modalities prescribed in cases of ''apasmara''. The epigenetic variation of the four types of ''apasmara'' and the categorization of etio-pathological factors to lead the epigenetic modification resulting into specific type of ''apasmara'' is worthy of study.   
+
There are four types of apasmara depending upon the predominance of ''dosha''. The first thing of significance is that all these are ''sharira [[dosha]]s'' and not ''manasa [[dosha]]s''. This implies that apasmara is predominantly a somatic disease in which psychological factors play a role in pathogenesis. The important aspect of management should be focused at the somatic level supported by psychotherapy. The role of genetic constitution is important in the study of clinical manifestations of apasmara as well as their response either to treatments involving allopathic anti-epileptic medications or to Ayurvedic treatment modalities. The diagnosis of dominance of ''[[dosha]]'' is also important in deciding the treatment modalities prescribed in cases of apasmara. The epigenetic variation of the four types of apasmara and the categorization of etio-pathological factors to lead the epigenetic modification resulting into specific type of apasmara is worthy of study.   
  
===== ''Agantu Apasmara'' =====
+
==== ''Agantu Apasmara'' ====
  
Chakrapani comments that ''Agantuka'' i.e. exogenous type of ''apasmara'' is excluded unlike ''unmada''. Thus Chakrapani rules out the possibility of external factors like ''deva, graha'' etc. to cause ''apasmara'' and emphasizes the endogenous patho-physiology of ''apasmara''. Charaka describes the possibility of exogenous factors affecting the individual to suffer from ''apasmara'' in a verse described later. The management of ''apasmara'' due to exogenous factors is similar to that described in the management of ''agantuja unmada''.   
+
Chakrapani comments that ''Agantuka'' i.e. exogenous type of apasmara is excluded unlike ''unmada''. Thus Chakrapani rules out the possibility of external factors like ''deva, graha'' etc. to cause apasmara and emphasizes the endogenous patho-physiology of apasmara. Charak describes the possibility of exogenous factors affecting the individual to suffer from apasmara in a verse described later. The management of apasmara due to exogenous factors is similar to that described in the management of ''agantuja unmada''.   
  
===== ''Skanda graha'' and ''Skandapasmara'' =====
+
==== ''Skanda graha'' and ''Skandapasmara'' ====
  
Per Ayurveda, children get afflicted by ''apasmara'' due to the effects of any of ''grahas'' (Sanskrit, means seizing) such as ''skandapasmara'' (due to the effects of ''graha''<ref> Sushruta, ‘Sushruta Samhita’, edited by Vaidya Jadavaji Trikamaji Acharya and Sharma PV, Eighth edition, Chaukhamba Orientalia, Varanasi; 2005 Uttara tantra 27/ 8-9.pg.659 </ref> <ref>Vagbhata, Ashtanga Hridayam, with the commentaries, ‘Sarvangasundara’ of Arunadatta and ‘Ayurvedarasayana’ of Hemadri collated by Dr.Anna Moreshvara Kunte, and Krishna Ramachandra  Shastri Navre, edited by Pt. Harishastri Paradakar Vaidya, Krishanadas Academy, Varanasi. Reprint 2000.3/6-11.pg.786-7  </ref>.), ''skanda'', etc. knowledge of features of nine evil spirits which seize children is described, ''skanda'' and ''skandapasmara'' are the first two evil spirits which when affect a child, the clinical presentation is similar to that of epilepsy as narrated below.  
+
Per [[Ayurveda]], children get afflicted by apasmara due to the effects of any of ''grahas'' (Sanskrit, means seizing) such as ''skandapasmara'' <ref>Sushruta. Uttara Tantra, Cha.27 Navagrahakritivijnaniya Adhyaya verse 8-9. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref> <ref name=Hridaya>Vagbhata. Uttara Sthana, Cha.3 Balagrahapratishedam Adhyaya verse 6-11. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.</ref> ''skanda'', etc. knowledge of features of nine evil spirits which seize children is described, ''skanda'' and ''skandapasmara'' are the first two evil spirits which when affect a child, the clinical presentation is similar to that of epilepsy as narrated below.  
  
 
A child seized by ''skanda graha'' has swelling of the eyes, smells like blood, has aversion to the breasts, distorted face, and eyelids or one eye having either loss of movement or more movements. The child could also be restless or irritable, have closed eyes, cry very little, hold its fists tight, and have hard bowel movement.  
 
A child seized by ''skanda graha'' has swelling of the eyes, smells like blood, has aversion to the breasts, distorted face, and eyelids or one eye having either loss of movement or more movements. The child could also be restless or irritable, have closed eyes, cry very little, hold its fists tight, and have hard bowel movement.  
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When the child is seized by ''skandapasmara'', it loses and regains consciousness, is irritable, makes dancing like movements with arms and legs, eliminates stools and passes urine accompanied with sound (crying), yawns more and emits froth from the mouth. These are the features of a child seized by the “friend of skanda graham”, i.e., ''skandapasmara''.
 
When the child is seized by ''skandapasmara'', it loses and regains consciousness, is irritable, makes dancing like movements with arms and legs, eliminates stools and passes urine accompanied with sound (crying), yawns more and emits froth from the mouth. These are the features of a child seized by the “friend of skanda graham”, i.e., ''skandapasmara''.
  
Similar to this, Vagbhata in Ashtanga Hridayam, has described the variants of the disease caused due to demons/evil spirits possessing the children. The cardinal signs of ''graha'' possession (or affliction) include continuous fever and crying. The general features are fear, too much yawning, movement of eyebrows, timidity, discharge of froth from mouth, upward gaze, biting of lips and teeth (grinding), wakefulness (absence of sleep), crying, moaning, aversion for the breast, change of voice, and scratching its own body or that of the mother by nails without any reason.<ref> Ibid Ashtanga Hrudayam Uttar Sthana.3/3-5. pp.786 </ref>  
+
Similar to this, Vagbhata in Ashtanga Hridayam, has described the variants of the disease caused due to demons/evil spirits possessing the children. The cardinal signs of ''graha'' possession (or affliction) include continuous fever and crying. The general features are fear, too much yawning, movement of eyebrows, timidity, discharge of froth from mouth, upward gaze, biting of lips and teeth (grinding), wakefulness (absence of sleep), crying, moaning, aversion for the breast, change of voice, and scratching its own body or that of the mother by nails without any reason. [A.H Uttara Sthana 3/3-5]<ref name=Hridaya/>
  
In conventional medicine, epilepsy in children is described in detail. However, the etiology of some variants of epilepsy is mentioned to be idiopathic. As described in context of ''skanda'' and ''skandapasmara'', the involvement of supernatural powers in causing ''apasmara'' is a matter of debate and falls in the purview of theology. Considering its importance and prevalence, ''apasmara'' of unknown etiology can be categorized as of the fifth type i.e. ''agantu apasmara''. Sushruta and his commentator Dallhana support this view that any variant of the disease which occurs without any reason, acutely and without any rational pathology shall be considered as ''agantu''. Per Charaka [Chikitsa 10/53], the etiopathology, clinical features and management of this fifth type are on the lines of ''agantu unmada''. As commented by Chakrapani, in case of ''agantu'' or ''bhutapasmara'', the etiology of being seized by some external factors is considered primary and the involvement (''anubabdha'') of ''dosha'' as secondary. It is important to note here that since clinical patho-physiology cannot take place without the involvement of ''doshas'', therefore ''agantu'' should technically be considered as one of the four doshic variants of ''apasmara'' mentioned earlier, in order to follow the ''sankhya niyam''a i.e. rules of numeral classification.
+
In conventional medicine, epilepsy in children is described in detail. However, the etiology of some variants of epilepsy is mentioned to be idiopathic. As described in context of ''skanda'' and ''skandapasmara'', the involvement of supernatural powers in causing apasmara is a matter of debate and falls in the purview of theology. Considering its importance and prevalence, apasmara of unknown etiology can be categorized as of the fifth type i.e. ''agantu apasmara''. Sushruta and his commentator Dallhana support this view that any variant of the disease which occurs without any reason, acutely and without any rational pathology shall be considered as ''agantu''. Per Charak [Cha.Sa.[[Chikitsa Sthana]] 10/53], the etiopathology, clinical features and management of this fifth type are on the lines of ''agantu unmada''. As commented by Chakrapani, in case of ''agantu'' or ''bhutapasmara'', the etiology of being seized by some external factors is considered primary and the involvement (''anubabdha'') of ''[[dosha]]'' as secondary. It is important to note here that since clinical patho-physiology cannot take place without the involvement of ''[[dosha]]s'', therefore ''agantu'' should technically be considered as one of the four doshic variants of apasmara mentioned earlier, in order to follow the ''sankhya niyam''a i.e. rules of numeral classification.
  
==== Premonitory signs of ''apasmara'' ====
+
=== Premonitory signs of apasmara ===
  
The table 1 depicts the premonitory signs of ''apasmara'' described in the Ayurvedic texts. Each sign has a specific patho-physiology in terms of ''dosha'' and ''dushya'' behind its manifestation. The enlisted signs are the alerting signals or premonitory symptoms of ''apasmara'' before the onset of seizures. The probable system involved as per conventional medicine is also enlisted for every sign, so that it would be easier to consider the pathophysiological similarities and differences between the two medical streams.   
+
The table 1 depicts the premonitory signs of apasmara described in the Ayurvedic texts. Each sign has a specific patho-physiology in terms of ''[[dosha]]'' and ''[[dushya]]'' behind its manifestation. The enlisted signs are the alerting signals or premonitory symptoms of apasmara before the onset of seizures. The probable system involved as per conventional medicine is also enlisted for every sign, so that it would be easier to consider the pathophysiological similarities and differences between the two medical streams.   
 
</div>
 
</div>
  
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|-
 
|-
 
! Bhrūvyudāsa  
 
! Bhrūvyudāsa  
| abnormal /  twitching of eyebrows  || vata – rajas  || majja || nervous system [NS]   
+
| abnormal /  twitching of eyebrows  || [[vata]] – rajas  || majja || nervous system [NS]   
 
|-
 
|-
 
! Satatam akshi vaikrutam   
 
! Satatam akshi vaikrutam   
| constant abnormal/ irregular movements of eyes  || vata – rajas  || majja || NS  
+
| constant abnormal/ irregular movements of eyes  || [[vata]] – rajas  || majja || NS  
 
|-
 
|-
 
! Ashabda shravanam   
 
! Ashabda shravanam   
| auditory hallucinations  || vata –rajas  || manas  ||  NS, psychiatric disorder  
+
| auditory hallucinations  || [[vata]] –rajas  || [[manas]] ||  NS, psychiatric disorder  
 
|-
 
|-
 
! Lala prastrava   
 
! Lala prastrava   
| excess secretion of saliva  || kapha || rasa  || NS, digestive system[DS]  
+
| excess secretion of saliva  || [[kapha]] || [[rasa]] || NS, digestive system[DS]  
 
|-
 
|-
 
! Singhanaka prastrava  
 
! Singhanaka prastrava  
| excess nasal mucus discharge || kapha || rasa  ||NS, respiratory system   
+
| excess nasal mucus discharge || [[kapha]] || [[rasa]] ||NS, respiratory system   
 
|-
 
|-
 
! Anannabhilashanam  
 
! Anannabhilashanam  
| lack of appetite  || kapha- Pitta  || rasa || DS, NS  
+
| lack of appetite  || [[kapha]]- [[Pitta]] || [[rasa]] || DS, NS  
 
|-
 
|-
 
! Arochaka   
 
! Arochaka   
| aversion to food and drinks [anorexia]  || Kapha –pitta –vata || rasa ||  DS, Psychiatric disorder  
+
| aversion to food and drinks [anorexia]  || [[Kapha]] –[[pitta]] –[[vata]] || [[rasa]] ||  DS, Psychiatric disorder  
 
|-
 
|-
 
! Avipaka  
 
! Avipaka  
| indigestion  || pitta || rasa || DS, NS  
+
| indigestion  || [[pitta]] || [[rasa]] || DS, NS  
 
|-
 
|-
 
! Hridaya graham   
 
! Hridaya graham   
| heavyness of precordium/ congestion/ constriction in cardiac region  || kapha, vata  || mamsa,majja || NS, musculo skeletal system,   
+
| heavyness of precordium/ congestion/ constriction in cardiac region  || [[kapha]], [[vata]]   || [[mamsa]],[[majja]] || NS, musculo skeletal system,   
 
|-
 
|-
 
! Kukshe aatopa   
 
! Kukshe aatopa   
| puffiness/ swelling in the hypogastric region  || vata, kapha  || rasa, purisha, mutra  || DS, urinary system   
+
| puffiness/ swelling in the hypogastric region  || [[vata]], [[kapha]] || [[rasa]], [[purisha]], [[mutra]] || DS, urinary system   
 
|-
 
|-
 
! Daurbalyam  
 
! Daurbalyam  
| debility, loss of strength || kapha, vata || rasa, mamsa, majja ||  NS, musculoskeletal system  
+
| debility, loss of strength || [[kapha]], [[vata]] || [[rasa]], [[mamsa]], [[majja]] ||  NS, musculoskeletal system  
 
|-
 
|-
 
! Asthibheda  
 
! Asthibheda  
| splitting / breaking [pain] sensation in bones || vata || asthi, majja || skeletal system   
+
| splitting / breaking [pain] sensation in bones || [[vata]] || [[asthi]], [[majja]] || skeletal system   
 
|-
 
|-
 
! Angamarda   
 
! Angamarda   
| generalized bodyache/ twisting/churning pain in body  || vata || mamsa, majja  || musculo-skeletal system, NS  
+
| generalized bodyache/ twisting/churning pain in body  || [[vata]] || [[mamsa]], [[majja]] || musculo-skeletal system, NS  
 
|-
 
|-
 
! Moha  
 
! Moha  
| confused state of mind [leading to lack of knowledge] || vata, kapha, Tama || rasa, majja ||  NS, psychiatric disorder  
+
| confused state of mind [leading to lack of knowledge] || [[vata]], [[kapha]], Tama || [[rasa]], [[majja]] ||  NS, psychiatric disorder  
 
|-
 
|-
 
! Tamas darshanam   
 
! Tamas darshanam   
| black outs / temporary loss of vision without alteration in consciousness  || pitta, vata  || rasa- rakta-majja  ||  cardio-vascular/ cerebro vascular  system, NS
+
| black outs / temporary loss of vision without alteration in consciousness  || [[pitta]], [[vata]] || [[rasa]]- [[rakta]]-[[majja]] ||  cardio-vascular/ cerebro vascular  system, NS
 
|-
 
|-
 
! Murchcha   
 
! Murchcha   
| syncope / a fatal condition characterized by loss of consciousness and postural tone due to vitiation of blood || pitta, kapha  || rasa, rakta, majja  || cardio-vascular/ cerebro vascular  system, NS  
+
| syncope / a fatal condition characterized by loss of consciousness and postural tone due to vitiation of blood || [[pitta]], [[kapha]] || [[rasa]], [[rakta]], [[majja]] || cardio-vascular/ cerebro vascular  system, NS  
 
|-
 
|-
 
! Abhikshnam Bhrama   
 
! Abhikshnam Bhrama   
| frequent vertigo/ dizziness  || pitta, vata, rajas  || rasa, rakta, rajas || cardio-vascular/ cerebro vascular  system, NS, psychiatric disorder   
+
| frequent vertigo/ dizziness  || [[pitta]], [[vata]], rajas  || [[rasa]], [[rakta]], rajas || cardio-vascular/ cerebro vascular  system, NS, psychiatric disorder   
 
|-
 
|-
 
! Swapne cha  || ! colspan="4" | In dreams  
 
! Swapne cha  || ! colspan="4" | In dreams  
 
|-
 
|-
 
! Mada  
 
! Mada  
|  slight intoxication, becoming out of senses showing uncanny or abnormal behaviour || rowspan="6" | vata, rajas, kapha || rasa, rakta, manas || rowspan="6" | Cardio-vascular/ Cerebro vascular  system, NS, psychiatric disorder
+
|  slight intoxication, becoming out of senses showing uncanny or abnormal behaviour || rowspan="6" | [[vata]], rajas, [[kapha]] || [[rasa]], [[rakta]], [[manas]] || rowspan="6" | Cardio-vascular/ Cerebro vascular  system, NS, psychiatric disorder
 
|-
 
|-
 
! Nartana  
 
! Nartana  
| dancing  || majja     
+
| dancing  || [[majja]]      
 
|-
 
|-
 
! Vyadhana   
 
! Vyadhana   
| needling like sensation ||  majja  
+
| needling like sensation ||  [[majja]] 
 
|-
 
|-
 
! Vyathana   
 
! Vyathana   
| pain  || majja     
+
| pain  || [[majja]]      
 
|-
 
|-
 
! Vepana   
 
! Vepana   
| tremors  ||  majja     
+
| tremors  ||  [[majja]]    
 
|-
 
|-
 
! Patanadini  
 
! Patanadini  
| falling etc. || rasa-rakta,
+
| falling etc. || [[rasa]]-[[rakta]],
 
majja     
 
majja     
 
|-
 
|-
Line 860: Line 1,144:
  
 
<div style="text-align:justify;">
 
<div style="text-align:justify;">
The abovementioned pre-clinical features are observed in the fourth stage of ''shatkriyakala'' (pathogenesis). These may be considered as aura in ''apasmara'' patients. These are important in view of prevention of ''apasmara'' progression to epileptic seizure. In conventional medicine text books, some of the above signs like auditory and visual hallucinations are referred. These signs need to be searched upon for their prevalence, categorization as per ''dosha'' dominance, involvement of ''dosha'' attributes in order to establish precise guidelines for early prevention and management of disease.     
+
The abovementioned pre-clinical features are observed in the fourth stage of ''shatkriyakala'' (pathogenesis). These may be considered as aura in apasmara patients. These are important in view of prevention of apasmara progression to epileptic seizure. In conventional medicine text books, some of the above signs like auditory and visual hallucinations are referred. These signs need to be searched upon for their prevalence, categorization as per ''[[dosha]]'' dominance, involvement of ''[[dosha]]'' attributes in order to establish precise guidelines for early prevention and management of disease.     
 
</div>
 
</div>
 
Table 2: Differentiation between types of apasmara  
 
Table 2: Differentiation between types of apasmara  
Line 930: Line 1,214:
 
Su: As described by Sushruta in Sushruta Samhita AH: As described in Ashtang Hridaya   
 
Su: As described by Sushruta in Sushruta Samhita AH: As described in Ashtang Hridaya   
 
<div style="text-align:justify;">       
 
<div style="text-align:justify;">       
The specific features of all the four types of ''apasmara'' are described in Table 2. ''Vata'' type of ''apasmara'' manifests itself with repeated seizures of short duration and increased frequency of attacks. The speed, severity and abnormality of movements are more in this case. This is due to ''chala'' (movable), ''laghu'' (light), and ''sukshma'' (minute) attributes of ''vata dosha''. ''Vata'' is the initiator of all activities including those of the body and the mind. The regulation and coordination of the sequence of sense and locomotor organs – mind-intellect-soul for attainment of knowledge is performed by ''vata''. ''Prana vata, udana vata'' and ''vyana vata'' are involved in the pathophysiology of ''apasmara''. The clinical manifestation of ''vataja'' ''apasmara'' may be due to repeated, excess, hyposynchronous discharges in neurons of the central nervous system. Transient hypoxia leading to dysregulation of brain functioning, and neurological diseases similar to epilepsy syndromes can be categorized under this type of ''apasmara''.   
+
The specific features of all the four types of apasmara are described in Table 2. ''[[Vata]]'' type of apasmara manifests itself with repeated seizures of short duration and increased frequency of attacks. The speed, severity and abnormality of movements are more in this case. This is due to ''chala'' (movable), ''laghu'' (light), and ''sukshma'' (minute) attributes of ''[[vata dosha]]''. ''[[Vata]]'' is the initiator of all activities including those of the body and the mind. The regulation and coordination of the sequence of sense and locomotor organs – mind-intellect-soul for attainment of knowledge is performed by ''[[vata]]''. ''Prana vata, udana vata'' and ''vyana vata'' are involved in the pathophysiology of apasmara. The clinical manifestation of ''vataja'' apasmara may be due to repeated, excess, hyposynchronous discharges in neurons of the central nervous system. Transient hypoxia leading to dysregulation of brain functioning, and neurological diseases similar to epilepsy syndromes can be categorized under this type of apasmara.   
  
In ''pitta apasmara'', the frequency, duration of paroxysms will be comparatively less than those observed in ''vata'' type. The ''ushna'' (hot) and ''tikshna'' (acrid) attributes of ''pitta'' are responsible for the pathology of paroxysms. ''Sadhaka pitta'' located at the heart and the functions responsible for accomplishment of activities are responsible for this ''apasmara''. ''Tamahpravesha'' is a sign primarily of ''pitta''-dominance in which metabolism or transformation at the cellular level might be an underlying pathology. Derangement of ''sadhaka pitta'' implies the decrement or depletion in psychological performance in ''apasmara'' patients. Since ''pitta'' is responsible for all metabolic activities, the derangement of metabolism at the cellular level is an important pathological factor and the enzymatic pathways might be held responsible. The types of epileptic syndromes originating due to metabolic disorders like hepatic encephalopathy can be categorized under this type. Changes in body temperature, excess thirst, and perspiration are specific differentiating features of ''pitta apasmara''. The cerebral conditions due to derangement of metabolisms can be enlisted here.   
+
In ''[[pitta]] apasmara'', the frequency, duration of paroxysms will be comparatively less than those observed in ''[[vata]]'' type. The ''ushna'' (hot) and ''tikshna'' (acrid) attributes of ''[[pitta]]'' are responsible for the pathology of paroxysms. ''Sadhaka pitta'' located at the heart and the functions responsible for accomplishment of activities are responsible for this apasmara. ''Tamahpravesha'' is a sign primarily of ''[[pitta]]''-dominance in which metabolism or transformation at the cellular level might be an underlying pathology. Derangement of ''sadhaka pitta'' implies the decrement or depletion in psychological performance in apasmara patients. Since ''[[pitta]]'' is responsible for all metabolic activities, the derangement of metabolism at the cellular level is an important pathological factor and the enzymatic pathways might be held responsible. The types of epileptic syndromes originating due to metabolic disorders like hepatic encephalopathy can be categorized under this type. Changes in body temperature, excess thirst, and perspiration are specific differentiating features of ''[[pitta]] apasmara''. The cerebral conditions due to derangement of metabolisms can be enlisted here.   
In cases of ''kaphaja apasmara'', the ''sthira'' (stable), ''manda'' (slow), and ''snigdha'' (unctuous) attributes of ''kapha'' are responsible for delayed onset, prolonged duration as well as minimal frequency of paroxysms in ''apasmara''. Excessive sleep and hypothermia specifically suggest ''kaphaja apasmara''. Hypoperfusion and hypovolemic conditions leading to cerebral dysfunction can be considered as attributes of ''kaphaja apasmara''.   
+
In cases of ''kaphaja apasmara'', the ''sthira'' (stable), ''manda'' (slow), and ''snigdha'' (unctuous) attributes of ''[[kapha]]'' are responsible for delayed onset, prolonged duration as well as minimal frequency of paroxysms in apasmara. Excessive sleep and hypothermia specifically suggest ''kaphaja apasmara''. Hypoperfusion and hypovolemic conditions leading to cerebral dysfunction can be considered as attributes of ''kaphaja apasmara''.   
  
Finally, the ''sannipatika'' type of ''apasmara'' presents itself with complex mixed features due to overlapping of all ''doshas''. The prognosis is poor leading to incurability of disease. This might be a mixed presentation of neuronal, endocrinal, circulatory and metabolic pathways.  
+
Finally, the ''sannipatika'' type of apasmara presents itself with complex mixed features due to overlapping of all ''[[dosha]]s''. The prognosis is poor leading to incurability of disease. This might be a mixed presentation of neuronal, endocrinal, circulatory and metabolic pathways.  
  
While considering the clinical pictures of a disease, the attributes of ''doshas'' responsible for variation in pathologies at somatic and psychological level should be emphasized. Important mechanisms of loss of consciousness and abnormal movements at the somatic level, and impairment of intelligence and memory at psycho-pathological levels needs to be focused. The epigenetic patterns related to particular signs and symptoms originated from ''doshic'' pathologies can be researched to reveal new treatment methods and management aspects. The genetic constitution of a person plays a significant role in making him prone to developing certain type of disorders. Therefore, as discussed above for ''vata apasmara'' can become more apparent after taking ''vata''-aggravating diet and lifestyle in ''vata prakriti'' individuals that can get alleviated by using ''vata shamana'' (i.e., ''vata''-pacifying) diet and lifestyle. Furthermore, if anti-epileptic drugs are used more judiciously depending upon the ''dosha'' and ''prakriti''-specific diagnosis, then the treatment regimen can be made much more precise leading to beneficial results in patients. As discussed in the section of predisposing factors, the preventive lifestyle and dietary regimens can be designed to prevent incidence of epilepsy, reduce the dose of drugs with supportive diet and lifestyle therapy and prevent further progression of disease. Therefore, training of epileptics regarding causative and avoidable factors is of utmost importance. The epigenetic variations in epileptics due to enlisted causative agents should be studied as a part of genomic and proteomic research.
+
While considering the clinical pictures of a disease, the attributes of ''[[dosha]]s'' responsible for variation in pathologies at somatic and psychological level should be emphasized. Important mechanisms of loss of consciousness and abnormal movements at the somatic level, and impairment of intelligence and memory at psycho-pathological levels needs to be focused. The epigenetic patterns related to particular signs and symptoms originated from ''doshic'' pathologies can be researched to reveal new treatment methods and management aspects. The genetic constitution of a person plays a significant role in making him prone to developing certain type of disorders. Therefore, as discussed above for ''[[vata]] apasmara'' can become more apparent after taking ''[[vata]]''-aggravating diet and lifestyle in ''[[vata]] [[prakriti]]'' individuals that can get alleviated by using ''[[vata]] shamana'' (i.e., ''[[vata]]''-pacifying) diet and lifestyle. Furthermore, if anti-epileptic drugs are used more judiciously depending upon the ''[[dosha]]'' and ''[[prakriti]]''-specific diagnosis, then the treatment regimen can be made much more precise leading to beneficial results in patients. As discussed in the section of predisposing factors, the preventive lifestyle and dietary regimens can be designed to prevent incidence of epilepsy, reduce the dose of drugs with supportive diet and lifestyle therapy and prevent further progression of disease. Therefore, training of epileptics regarding causative and avoidable factors is of utmost importance. The epigenetic variations in epileptics due to enlisted causative agents should be studied as a part of genomic and proteomic research.
  
==== Differential diagnosis of ''apasmara'' ====
+
=== Differential diagnosis of apasmara ===
  
Other disorders such as ''mada'' (intoxication) and ''murchcha'' (syncope) also show the signs of loss of consciousness, but ones without convulsions. In ''unmada'', there is impairment of ''buddhi'', and it does not manifest itself with loss of consciousness. ''Akshepa'' (abnormal movements) is a ''vata''-predominant disease characterized with convulsions, but the consciousness is intact and there is no froth discharge. This makes ''apasmara'' a distinct disease apart from other disorders.  
+
Other disorders such as ''mada'' (intoxication) and ''murchcha'' (syncope) also show the signs of loss of consciousness, but ones without convulsions. In ''unmada'', there is impairment of ''[[buddhi]]'', and it does not manifest itself with loss of consciousness. ''Akshepa'' (abnormal movements) is a ''[[vata]]''-predominant disease characterized with convulsions, but the consciousness is intact and there is no froth discharge. This makes apasmara a distinct disease apart from other disorders.
  
==== Prognosis of ''apasmara'' ====
+
=== Prognosis of apasmara ===
  
Epilepsy due to vitiation of all the three doshas and showing all clinical features of the ''sannipatika'' variant (i.e., of all the other three ''doshic'' variants) is chronic in nature and that, which has occurred in a person with excess degenerative condition and depleted ''dhatus'', is considered incurable. In case of degenerative conditions and chronic diseases, any case of ''apasmara'' due to vitiation of even a single ''dosha'' can be considered incurable.  
+
Epilepsy due to vitiation of all the three [[dosha]]s and showing all clinical features of the ''sannipatika'' variant (i.e., of all the other three ''doshic'' variants) is chronic in nature and that, which has occurred in a person with excess degenerative condition and depleted ''[[dhatu]]s'', is considered incurable. In case of degenerative conditions and chronic diseases, any case of apasmara due to vitiation of even a single ''[[dosha]]'' can be considered incurable.  
 
   
 
   
Bad prognostic signs of ''apasmara'' patients can often turn fatal. If one, in his wakeful state sees darkness where there is no darkness and hears all types of sound even when there is no sound, he succumbs to ''apasmara''. If a patient, while dancing in an intoxicated state is caught by a ''preta'' (soul of a dead person) with his head facing downwards, he is sure to succumb to an attack of ''apasmara''.  
+
Bad prognostic signs of apasmara patients can often turn fatal. If one, in his wakeful state sees darkness where there is no darkness and hears all types of sound even when there is no sound, he succumbs to apasmara. If a patient, while dancing in an intoxicated state is caught by a ''preta'' (soul of a dead person) with his head facing downwards, he is sure to succumb to an attack of apasmara.
  
==== Reasons behind aggressive and dormant stages of ''apasmara'' ====
+
=== Reasons behind aggressive and dormant stages of apasmara ===
 
   
 
   
From the above sections, it is clear that ''apasmara'' occurs in episodes. The patient after seizure regains consciousness like waking up from sleep (''suptavat pratibuddhyate''). Therefore, there are two stages of disease : one is aggressive stage of ''doshas'' and the second is dormant stage of ''doshas''. Sushruta describes that there are two forms of pathogenesis: One form follows the six stages viz. ''sanchaya'' etc.(''kramopayogad'') of the disease in sequence and takes considerable time to manifest disease with gradual onset. The other form manifests acutely in a short time (''kshanikatwat''). The first form is seen in ''nija'' (endogenous) pathologies of disease. The other form is seen in ''agantu'' (exogenous) ''apasmara''. Sushruta gives examples of a seed in the ground that sprouts only during ''sharad ritu'' (autumn) though it rains at other times. Analogous to this example, the virulent form of the disease develops due to a ''dosha'' getting aggravated in very short time and manifesting its different symptoms due to some factors catalyzing the accelerated aggravation. It is quite clear from the detailed descriptions in this chapter, though, that all forms of ''apasmara'' are caused by ''dosha'' only.<ref> Ibid Sushruta Samhita Uttar Tantra 61/18-21.pp.800-801. </ref>
+
From the above sections, it is clear that apasmara occurs in episodes. The patient after seizure regains consciousness like waking up from sleep (''suptavat pratibuddhyate''). Therefore, there are two stages of disease : one is aggressive stage of ''[[dosha]]s'' and the second is dormant stage of ''[[dosha]]s''. Sushruta describes that there are two forms of pathogenesis: One form follows the six stages viz. ''sanchaya'' etc.(''kramopayogad'') of the disease in sequence and takes considerable time to manifest disease with gradual onset. The other form manifests acutely in a short time (''kshanikatwat''). The first form is seen in ''nija'' (endogenous) pathologies of disease. The other form is seen in ''agantu'' (exogenous) apasmara. Sushruta gives examples of a seed in the ground that sprouts only during ''sharad ritu'' (autumn) though it rains at other times. Analogous to this example, the virulent form of the disease develops due to a ''[[dosha]]'' getting aggravated in very short time and manifesting its different symptoms due to some factors catalyzing the accelerated aggravation. It is quite clear from the detailed descriptions in this chapter, though, that all forms of apasmara are caused by ''[[dosha]]'' only. [Su.Sa.Uttara Tantra 61/1821]
 
   
 
   
The example states the fact that favorable environment for precipitating factors plays major role in diseases episodes. Depending upon the defense system of the body – its natural and acquired immunity -  as the background for disease and factors aggravating the ''dosha'' as offending agents, the interaction between the two defines severity, intensity and frequency of occurrence of episodes of disease as shown in chart below.
+
The example states the fact that favorable environment for precipitating factors plays major role in disease episodes. Depending upon the defense system of the body – its natural and acquired immunity -  as the background for disease and factors aggravating the ''[[dosha]]'' as offending agents, the interaction between the two defines severity, intensity and frequency of occurrence of episodes of disease as shown in chart. [ Fig.4: Manifestation of episodes ]
[[File:mainfastation.png]]<br>
+
[[File:mainfastation.png|500px|'''Fig.4: Manifestation of episodes'''|thumb]]<br>  
 
Therefore, for prevention and management of a disease, it is important either to build up the strength of defense system i.e. improving the ''sharira bala'' (physical strength) and ''sattva bala'' (mental strength), or pacify/weaken the aggravating causative factors or both.
 
Therefore, for prevention and management of a disease, it is important either to build up the strength of defense system i.e. improving the ''sharira bala'' (physical strength) and ''sattva bala'' (mental strength), or pacify/weaken the aggravating causative factors or both.
  
==== Management of ''Apasmara'' ====
+
=== Management of apasmara ===
  
Although the management of ''apasmara'' is described further in [[Chikitsa Sthana]], principles of management are given in this chapter. The curable types of epilepsy should be carefully treated with strong elimination and alleviation therapies according to the vitiated dosha. ''Doshas'' present in the vessels above the heart need to be removed which require strong measures requiring medicines having higher penetrability, higher potency and highest bio-availability. With this objective, ''tikshna samshodhana'' (strong elimination) and ''samshamana'' (alleviation therapies) are employed. When extrinsic causative factors are involved (''agantu apasmara''), then ''mantras'' etc., will be useful.
+
Although the management of apasmara is described further in [[Chikitsa Sthana]], principles of management are given in this chapter. The curable types of epilepsy should be carefully treated with strong elimination and alleviation therapies according to the vitiated [[dosha]]. ''[[Dosha]]s'' present in the vessels above the heart need to be removed which require strong measures requiring medicines having higher penetrability, higher potency and highest bio-availability. With this objective, ''tikshna samshodhana'' (strong elimination) and ''samshamana'' (alleviation therapies) are employed. When extrinsic causative factors are involved (''agantu apasmara''), then ''mantras'' etc., will be useful.
  
The rationale behind advocating strong elimination therapies is the deeper location and excess vitiated state of ''doshas''. As described in patho-physiology earlier the ''dosha'' are in dormant state in the vessels above heart. Therefore to remove these ''dosha'', strong eliminatory therapies are needed. The strength of the prescribed medicine is decided by their higher penetrability, potency and bio-availability.  
+
The rationale behind advocating strong elimination therapies is the deeper location and excess vitiated state of ''[[dosha]]s''. As described in patho-physiology earlier the ''[[dosha]]'' are in dormant state in the vessels above heart. Therefore to remove these ''[[dosha]]'', strong eliminatory therapies are needed. The strength of the prescribed medicine is decided by their higher penetrability, potency and bio-availability.
+
 
==== Practical application of principles ====
+
=== Practical application of principles ===
  
 
All the abovementioned principles are practically applicable. The methods for further research include the following:
 
All the abovementioned principles are practically applicable. The methods for further research include the following:
Line 969: Line 1,253:
 
#Supporting the clinical presentation with data of research papers on survey studies  
 
#Supporting the clinical presentation with data of research papers on survey studies  
 
#Preparing Checklist and  proforma for  
 
#Preparing Checklist and  proforma for  
##Diagnosis of states susceptible for suffering from ''apasmara''
+
##Diagnosis of states susceptible for suffering from apasmara  
##Diagnosis of aura stage or premonitory stage of ''apasmara'' for early identification of status epilepticus in order to train the patient and arrange necessary preventive measures  
+
##Diagnosis of aura stage or premonitory stage of apasmara for early identification of status epilepticus in order to train the patient and arrange necessary preventive measures  
#Diagnosis of ''apasmara'' and specific types of ''apasmara'' based on clinical presentation  
+
#Diagnosis of apasmara and specific types of apasmara based on clinical presentation  
  
 
=== Research areas ===
 
=== Research areas ===
 
   
 
   
#Evaluation studies of various epigenetic pathways in conjunction with the patho-physiology of ''apasmara''
+
#Evaluation studies of various epigenetic pathways in conjunction with the patho-physiology of apasmara  
#Clinical correlation with modern radiological investigations like CT etc. and EEG for better clinical diagnosis of ''apasmara''
+
#Clinical correlation with modern radiological investigations like CT etc. and EEG for better clinical diagnosis of apasmara  
#Enlisting newly introduced disease commonly observed in society into the umbrella of ''apasmara'' e.g. Alzheimer’s dementia, depression etc.  
+
#Enlisting newly introduced disease commonly observed in society into the umbrella of apasmara e.g. Alzheimer’s dementia, depression etc.  
#Retrospective analyses of all signs and symptoms enlisted in the modern text books and formulating probable ''samprapti'' / pathophysiology (''dosha-dushya sammurchchna'') based on ''dosha'' dominance behind manifestation of each sign and symptom can be formulated for better understanding in Ayurvedic perspective.  
+
#Retrospective analyses of all signs and symptoms enlisted in the modern text books and formulating probable ''samprapti'' / pathophysiology (''dosha-dushya sammurchchna'') based on ''[[dosha]]'' dominance behind manifestation of each sign and symptom can be formulated for better understanding in Ayurvedic perspective.  
#Assessment criteria in Ayurveda and modern science, modern investigation methods and technologies, biomarkers which are well established may be enlisted.
+
#Assessment criteria in [[Ayurveda]] and modern science, modern investigation methods and technologies, biomarkers which are well established may be enlisted.
  
=== Further reading ===
+
=== Research works done on apasmara at post graduate/post doctoral level: ===
 +
 
 +
'''Institute for Post Graduate Teaching & Research in [[Ayurveda]], Gujarat Ayurved University, Jamnagar, Gujarat, India.'''
  
Thesis works done on apasmara:
 
Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India.
 
 
1. Pandya M.B. Shukla C.P. Apasmara [A Treatise on Epilepsy].1962. P.G.Thesis.
 
1. Pandya M.B. Shukla C.P. Apasmara [A Treatise on Epilepsy].1962. P.G.Thesis.
 +
 
2. Sutariya Bharati.A Clinical Study on the role of Rasayana Drugs in the management of Apasmara.1988. P.G.Thesis.  
 
2. Sutariya Bharati.A Clinical Study on the role of Rasayana Drugs in the management of Apasmara.1988. P.G.Thesis.  
 +
 
3. Usha K.S. Singh Gurdip. A Clincal Study on Apasmara [Epilespy] & its management with Maha Panchagavya Ghrita. 2001.P.G.Thesis.   
 
3. Usha K.S. Singh Gurdip. A Clincal Study on Apasmara [Epilespy] & its management with Maha Panchagavya Ghrita. 2001.P.G.Thesis.   
Faculty of Ayurveda, Banaras Hindu University, Varanasi:  
+
 
 +
'''Faculty of [[Ayurveda]], Banaras Hindu University, Varanasi:'''
 +
 
 
4. Dwivedi KK. A Clinicalstudy of Medhya Rasayana therapy in Apasmara.1989. PG thesis.   
 
4. Dwivedi KK. A Clinicalstudy of Medhya Rasayana therapy in Apasmara.1989. PG thesis.   
SDM Hassan:  
+
 
 +
'''SDM Hassan:'''
 +
 
 
5. Shetty Suhas Kumar. A comparative study of Brahmi Ghrita as Shamana & Brumhana sneha in Apasmara.2001-02
 
5. Shetty Suhas Kumar. A comparative study of Brahmi Ghrita as Shamana & Brumhana sneha in Apasmara.2001-02
 
6. Unni G. Effect of Kushmanda Ghrita in Apasmara.2002.
 
6. Unni G. Effect of Kushmanda Ghrita in Apasmara.2002.
National Institute of Ayurveda, Jaipur :
+
 
 +
'''National Institute of [[Ayurveda]], Jaipur :'''
 +
 
 
7. Bhatnagar P. Antardhooma evum Bahirdhooma Tamra sindoora kalpana evum Apasmara Roga par Prabhavatmaka Adhyayana. 1992.
 
7. Bhatnagar P. Antardhooma evum Bahirdhooma Tamra sindoora kalpana evum Apasmara Roga par Prabhavatmaka Adhyayana. 1992.
 +
 
8. Sharma U.K. Apasmara me Samshodhana poorvaka Vacha Churna evum Smritisagar Rasa ka Chikitsatmaka Adhyayana.1999.  
 
8. Sharma U.K. Apasmara me Samshodhana poorvaka Vacha Churna evum Smritisagar Rasa ka Chikitsatmaka Adhyayana.1999.  
Ayurveda College, Mysore:
+
 
 +
'''[[Ayurveda]] College, Mysore:'''
 +
 
 
9. Yatheesha HN. To evaluate the effect of Brahmi Ghrita & Vacha choorna in the management of Apasmara- A controlled clinical study. 2003.  
 
9. Yatheesha HN. To evaluate the effect of Brahmi Ghrita & Vacha choorna in the management of Apasmara- A controlled clinical study. 2003.  
Shri Ayurveda College, Nagpur, Maharashtra :
+
 
 +
'''Shri [[Ayurveda]] College, Nagpur, Maharashtra :'''
 +
 
 
10. Potbhare SM.Comparative Clinical study of role of Saraswata Churna in Apasmara.1995.
 
10. Potbhare SM.Comparative Clinical study of role of Saraswata Churna in Apasmara.1995.
Tilak Ayurveda Mahavidyalaya, Pune, Maharashtra:
+
 
 +
'''Tilak [[Ayurveda]] Mahavidyalaya, Pune, Maharashtra:'''
 +
 
 
11. Kuber Asmita. Apasmara grandhokta hetu va pratyakshataha adhalanare hetu yancha taulanika Abhyasa. 2000.  
 
11. Kuber Asmita. Apasmara grandhokta hetu va pratyakshataha adhalanare hetu yancha taulanika Abhyasa. 2000.  
Trivendrum:  
+
 
 +
'''Trivendrum:'''
 +
 
 
12.  Nagarajan C. Apasmara & its management- A critical study. 1991.
 
12.  Nagarajan C. Apasmara & its management- A critical study. 1991.
 +
 
13. Manju GL. Efficacy of Kushmanada Swarasa ghrita in Apasmara.2003.
 
13. Manju GL. Efficacy of Kushmanada Swarasa ghrita in Apasmara.2003.
 +
 
14. Murthy Niranjan.Aetio-pathogenesis and principles of management of Apasmara. 1999.  
 
14. Murthy Niranjan.Aetio-pathogenesis and principles of management of Apasmara. 1999.  
 +
 
15. Indukala PR. A classical study on Majja in relation with the manifestation of Apasmara. 2003.       
 
15. Indukala PR. A classical study on Majja in relation with the manifestation of Apasmara. 2003.       
Books on Manasa Roga:  
+
 
 +
'''Reference books on Manasa Roga further reading:'''
 +
 
 
1. Thakar VJ. Man ane Manas Roga
 
1. Thakar VJ. Man ane Manas Roga
 +
 
2. Singh RH. Ayurvediya Manasa Roga Vijnana.
 
2. Singh RH. Ayurvediya Manasa Roga Vijnana.
 +
 
3. Pathak Balakrishna. Ayurvediya Bhutavidya Vivechana  
 
3. Pathak Balakrishna. Ayurvediya Bhutavidya Vivechana  
 +
 
4. Murthy ARV. Rationale of Ayurvedic Psychiatry.
 
4. Murthy ARV. Rationale of Ayurvedic Psychiatry.
5. Murthy ARV. Mind in Ayurveda and Indian traditions.  
+
 
 +
5. Murthy ARV. Mind in [[Ayurveda]] and Indian traditions.  
 +
 
 
6. Gupta SP. Psychopathology in Indian Medicine.
 
6. Gupta SP. Psychopathology in Indian Medicine.
7. Nanal Ramesh. Mana Ani Ayurveda.
+
 
 +
7. Nanal Ramesh. Mana Ani [[Ayurveda]].
  
 
=== Research papers published ===
 
=== Research papers published ===
Mervyn j. Eadie. Peter f. Bladin. John libbey. A disease once sacred. A history of the medical understanding of epilepsy. Brain (2002) 125 (2): 441-442.   
+
 
Manyam BV. Epilepsy in ancient India. Epilepsia. 1992 May-Jun;33(3):473-5.
+
*Mervyn j. Eadie. Peter f. Bladin. John libbey. A disease once sacred. A history of the medical understanding of epilepsy. Brain (2002) 125 (2): 441-442.   
Manyam BV. Dementia in Ayurveda. J Altern Complement Med. 1999 Feb;5(1):81-8.
+
 
Ven Murthy MR, Ranjekar PK, Ramassamy C, Deshpande M. Scientific basis for the use of Indian ayurvedic medicinal plants in the treatment of neurodegenerative disorders: Ashwagandha. Cent Nerv Syst Agents Med Chem. 2010 Sep 1;10(3):238-46.
+
*Manyam BV. Epilepsy in ancient India. Epilepsia. 1992 May-Jun;33(3):473-5.
Singh R.H., Murthy A.R.V. Medhya Rasayana Therapy in the management of Apasmara Vis-A-Vis Epilepsies. The Journal of Research and Education in Indian Medicine.1989.8 [1]:13-16.  
+
 
Dwivedi K.K. & Singh R.H. A Clinical Study of Medhya Rasayana Therapy in the management of Convulsive Disorders. Journal of Research in Ayurveda and Siddha.1992:13[3-4]: 97-106.
+
*Manyam BV. Dementia in [[Ayurveda]]. J Altern Complement Med. 1999 Feb;5(1):81-8.
Geetha L, Shetty S K, Prakash N B. A Randomized Control Trail of Brahmi Gritha In Apasmara With Reference To Generalized Tonic Clonic Seizures. 4th World Ayurveda Congress and Arogya Expo proceedings Pp. 135-136, 9-13 December 2010, Bengaluru, Karnataka, India.
+
 
M.H. Hakim, M.M.H. Siddiqui. A.B. Khan. Anti-epileptic activity of Ustukhudus (Lavandula stoechas) – In a case of secondary epilepsy (A Case Report). Hamdard Medicus.1991.34[ 3] 33-39.
+
*Ven Murthy MR, Ranjekar PK, Ramassamy C, Deshpande M. Scientific basis for the use of Indian ayurvedic medicinal plants in the treatment of neurodegenerative disorders: Ashwagandha. Cent Nerv Syst Agents Med Chem. 2010 Sep 1;10(3):238-46.
Hakim M.H. Siddiqui, M.M.H. Siddiqui, A. Ismail, S.A.H. Jafri. Secondary (Symptomatic) epilepsy, an uncommon presentation. The Antiseptic.May 1991. 88[5].231-233.
+
 
 +
*Singh R.H., Murthy A.R.V. Medhya Rasayana Therapy in the management of Apasmara Vis-A-Vis Epilepsies. The Journal of Research and Education in Indian Medicine.1989.8 [1]:13-16.  
 +
 
 +
*Dwivedi K.K. & Singh R.H. A Clinical Study of Medhya Rasayana Therapy in the management of Convulsive Disorders. Journal of Research in [[Ayurveda]] and Siddha.1992:13[3-4]: 97-106.
 +
 
 +
*Geetha L, Shetty S K, Prakash N B. A Randomized Control Trail of Brahmi Gritha In Apasmara With Reference To Generalized Tonic Clonic Seizures. 4th World [[Ayurveda]] Congress and Arogya Expo proceedings Pp. 135-136, 9-13 December 2010, Bengaluru, Karnataka, India.
 +
 
 +
*M.H. Hakim, M.M.H. Siddiqui. A.B. Khan. Anti-epileptic activity of Ustukhudus (Lavandula stoechas) – In a case of secondary epilepsy (A Case Report). Hamdard Medicus.1991.34[ 3] 33-39.
 +
 
 +
*Hakim M.H. Siddiqui, M.M.H. Siddiqui, A. Ismail, S.A.H. Jafri. Secondary (Symptomatic) epilepsy, an uncommon presentation. The Antiseptic.May 1991. 88[5].231-233.
 +
 
 
</div>
 
</div>
=====References=====
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=== Related Chapters ===
 +
 
 +
* [[Apasmara Chikitsa]]
 +
 
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==References==
 
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Latest revision as of 08:08, 23 February 2024

Cite.png

Nidana Sthana Chapter 8. Diagnosis and etiopathogenesis of seizure disorders

Apasmara Nidana
Section/Chapter Nidana Sthana Chapter 8
Preceding Chapter Unmada Nidana
Succeeding Chapter None
Other Sections Sutra Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana
Translator and commentator Deole Y. S.
Reviewer Khandel S.K
Editors Khandel S.K, Godatwar P., Deole Y.S., Basisht G.
Year of publication 2020
Publisher Charak Samhita Research, Training and Skill Development Centre
DOI 10.47468/CSNE.2020.e01.s02.009

Abstract

This chapter deals with another psychiatric disorder leading to transient loss of consciousness termed as Apasmara. It describes causative factors, predisposing conditions, pathogenesis, signs, types, and prognosis of apasmara. The clinical presentation of this disease simulates the seizure disorders described in conventional medical literature. Apasmara is a common neuropsychiatric disorder characterized by intermittent loss of consciousness, memory, abnormal movements and blackouts. This chapter explores the basic principles of psychiatric disorders involving memory, mind, consciousness and intellect. These disorders are marked by major pathological obstacles in perception, impaired intellectual functioning, orientation, co-ordination and consciousness. Their management includes avoidance of etiological factors as well as pharmacological and non-pharmacological treatment (including psychological and spiritual therapies). The basic principles described in the present chapter can be helpful in preventing and managing neuro-psychiatric disorders like apasmara in a better way. This chapter also deals with some important aspects of diagnosis. It explains how one disease can trigger another disease i.e. Nidanarthakara roga, leading to the presence of two or more diseases at the same time. This chapter lays down some principles of diagnosis to manage such conditions as well.

Keywords: apasmara, transient loss of memory, seizure disorders, epilepsy, mind-heart connection, mind-brain connection.


Introduction

In this important section dealing with the diagnoses of some common disorders of the body and the mind, this chapter deals with apasmara, a disorder afflicting the mind and sharing similar etiological and pathological factors as unmada (the subject of the preceding chapter). apasmara (Sanskrit for apa (to lose) or leave, and smara (memory)) is a psychosomatic disorder involving memory, intellect and mind and present with cardinal features such as transient loss of memory, abnormal movements of body and blackouts. apasmara is counted, in Ayurvedic texts, among the eight mahagada (most dreadful diseases). The extent of knowledge on the disease indicates that it must have been quite prevalent in antiquity. Ayurvedic scholars have observed that apasmara simulates epilepsy in its features[1] [2]. Epilepsy is a common neuropsychiatric condition involving mainly the brain, nervous system and the psyche. However, Ayurveda emphasizes heart, the abode of consciousness and mind, as its core pathological site while covering diseases of memory, intellect as well as psyche under the umbrella of apasmara.

Causative factors of apasmara can be categorized under dietary, lifestyle, psychological and iatrogenic factors. Vitiated doshas get through the vessels of the heart and when exposed to predisposing psychological factors like excess worry, grief, anger, and fear, move upwards from the heart, the abode of all consciousness, to the brain, afflicting the senses while altering memory. This eventually leads to apasmara. The etiology of the disease and specific features of the dominant doshas involved, and nidanarthakara roga (one disease causing other disease) and its importance in diagnosis and treatment have been described in detail in this chapter, with some important aspects of diagnosis addressed. In some cases, both diseases (the causative and the secondary ones) coexist while in other cases, the causative disease disappears and the new disease remains present. Thus, this chapter, while focusing on apasmara, also talks of complications that lead to secondary conditions and their treatment.

Sanskrit Text, Transliteration and English Translation

अथातोऽपस्मारनिदानं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

athātō'pasmāranidānaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAto~apasmAranidAnaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter "Apasmara Nidana" (Diagnosis and etiopathogenesis of seizure disorders). Thus said Lord Atreya. [1-2]

Four types of apasmara

इह खलु चत्वारोऽपस्मारा भवन्ति वातपित्तकफसन्निपातनिमित्ताः ||३||

iha khalu catvārō'pasmārā bhavanti vātapittakaphasannipātanimittāḥ||3||

iha khalu catvAro~apasmArA bhavanti vAtapittakaphasannipAtanimittAH||3||

There are four types of apasmara caused by vata, pitta, kapha and sannipatika (combination of all the three doshas).[3]

Persons prone to apasmara

त एवंविधानां प्राणभृतां क्षिप्रमभिनिर्वर्तन्ते; तद्यथा- रजस्तमोभ्यामुपहतचेतसामुद्भ्रान्तविषमबहुदोषाणां समलविकृतोपहितान्यशुचीन्यभ्यवहारजातानि वैषम्ययुक्तेनोपयोगविधिनोपयुञ्जानानां तन्त्रप्रयोगमपि च विषममाचरतामन्याश्च शरीरचेष्टा विषमाः समाचरतामत्युपक्षयाद्वा दोषाः प्रकुपिता: रजस्तमोभ्यामुपहतचेतसामन्तरात्मनः श्रेष्ठतममायतनं हृदयमुपसृत्योपरि तिष्ठन्ते, तथेन्द्रियायतनानि च | तत्र चावस्थिताः सन्तो यदा हृदयमिन्द्रियायतनानि चेरिताः कामक्रोधभयलोभमोहहर्षशोकचिन्तोद्वेगादिभिः सहसाऽभिपूरयन्ति, तदा जन्तुरपस्मरति ||४||

ta ēvaṁvidhānāṁ prāṇabhr̥tāṁ kṣipramabhinirvartantē; tadyathā- Rajas tamōbhyāmupahatacētasāmudbhrāntaviṣamabahudōṣāṇāṁ samalavikr̥tōpahitānyaśucīnyabhyavahārajātāni vaiṣamyayuktēnōpayōgavidhinōpayuñjānānāṁ tantraprayōgamapi ca viṣamamācaratāmanyāśca śarīracēṣṭā viṣamāḥ samācaratāmatyupakṣayādvā dōṣāḥ prakupitā Rajas tamōbhyāmupahatacētasāmantarātmanaḥ śrēṣṭhatamamāyatanaṁ hr̥dayamupasr̥tyōpari tiṣṭhantē, tathēndriyāyatanāni ca| tatra cāvasthitāḥ santō yadā hr̥dayamindriyāyatanāni cēritāḥ kāmakrōdhabhayalōbhamōhaharṣaśōkacintōdvēgādibhiḥ sahasā'bhipūrayanti, tadā jantur Apasmarati||4||

ta evaMvidhAnAM prANabhRutAM kShipramabhinirvartante; tadyathA-rajastamobhyAmupahatacetasAmudbhrAntaviShamabahudoShANAMsamalavikRutopahitAnyashucInyabhyavahArajAtAni vaiShamyayuktenopayogavidhinopayu~jjAnAnAMtantraprayogamapi ca viShamamAcaratAmanyAshca sharIraceShTA viShamAHsamAcaratAmatyupakShayAdvA doShAH prakupitA rajastamobhyAmupahatacetasAmantarAtmanaHshreShThatamamAyatanaM hRudayamupasRutyopari tiShThante, tathendriyAyatanAni ca| tatra cAvasthitAH santo yadA hRudayamindriyAyatanAni ceritAHkAmakrodhabhayalobhamohaharShashokacintodvegAdibhiH sahasA~abhipUrayanti, tadAjanturapasmarati||4||

Individuals get quickly afflicted with apasmara if:

  • the mind of an individual is afflicted by rajas (mental dosha associated with hyperactivity) and tamas (mental dosha associated with hypoactivity);
  • the three sharira doshas are imbalanced and excessively aggravated;
  • an individual takes food that is impure, untimely, decomposed, possessing antagonistic properties, or touched/cooked by unclean hands
  • an individual follows improper methods (of diet and lifestyle, conduct described in Ayurveda) and neglects prescribed rules;
  • an individual observes improper techniques (of treatment) and resorts to unhealthy regimen and behavior
  • an individual practices improper bodily movements and follows improper postures
  • an individual suffers from excessive degeneration or debility.

In the situations mentioned above, the doshas get aggravated and affect individuals whose minds are already afflicted by rajas and tamas. The doshas (so aggravated) pervade the heart which is, as mentioned earlier, the abode of consciousness, as well as the sense organs. While there, the doshas get further aggravated by emotions such as passion, anger, fear, greed, attachment, excitement, grief, anxiety, perturbation etc., consequently spreading throughout the heart and the sense organs. The individual is then said to have been afflicted with apasmara. [4]

Characteristic features of apasmara

अपस्मारं पुनः स्मृतिबुद्धिसत्त्वसम्प्लवाद्बीभत्सचेष्टमावस्थिकं तमः प्रवेशमाचक्षते ||५||

apasmāraṁ punaḥ smr̥ti buddhi sattva samplavādbībhatsacēṣṭamāvasthikaṁ tamaḥ pravēśamācakṣatē||5||

apasmAraM punaH smRutibuddhisattvasamplavAdbIbhatsaceShTamAvasthikaM tamaHpraveshamAcakShate||5||

apasmara is characterized by occasional loss of consciousness associated with aberrant activities (like vomiting of froth and abnormal postures of the body) and behavior, due to perversion of memory, intellect and other psychic faculties. [5]

तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- भ्रूव्युदासः सततमक्ष्णोर्वैकृतमशब्दश्रवणंलालासिङ्घाणप्रस्रवणमनन्नाभिलषणमरोचकाविपाकौ हृदयग्रहः कुक्षेराटोपो दौर्बल्यमस्थिभेदोऽङ्गमर्दो मोहस्तमसो दर्शनंमूर्च्छा भ्रमश्चाभीक्ष्णं स्वप्ने च मदनर्तनव्यधनव्यथनवेपनपतनादीनीति ||६||

ततोऽनन्तरमपस्माराभिनिर्वृत्तिरेव ||७||

tasyēmāni pūrvarūpāṇi bhavanti; tadyathā- bhrūvyudāsaḥ satatamakṣṇōrvaikr̥tamaśabdaśravaṇaṁ lālāsiṅghāṇaprasravaṇamanannābhilaṣaṇamarōcakāvipākau hr̥dayagrahaḥ kukṣērāṭōpō daurbalyamasthibhēdō'ṅgamardō mōhasTamasō darśanaṁ mūrcchā bhramaścābhīkṣṇaṁ svapnē ca madanartanavyadhanavyathanavēpanapatanādīnīti||6||

tatō'nantaramapasmārābhinirvr̥ttirēva||7||

tasyemAni pUrvarUpANi bhavanti; tadyathA- bhrUvyudAsaHsatatamakShNorvaikRutamashabdashravaNaMlAlAsi~gghANaprasravaNamanannAbhilaShaNamarocakAvipAkau hRudayagrahaH kukSherATopodaurbalyamasthibhedo~a~ggamardo mohastamaso darshanaM mUrcchA bhramashcAbhIkShNaM svapneca madanartanavyadhanavyathanavepanapatanAdInIti||6||

tato~anantaramapasmArAbhinirvRuttireva||7||

Premonitory symptoms of apasmara include contraction of eyebrows, erratic and constant movement of eyes, auditory hallucinations, excessive salivation, and nasal discharge. There is frequent accompaniment of anorexia, indigestion, and general disinclination towards food, chest congestion, distension of the lower abdomen accompanied with gurgling sound, weakness, cracking pain in bones and malaise, unconsciousness, a feeling of despondency or depression, fainting and giddiness, and frequent dreams of scenes of intoxication, dancing, murdering, aching, shivering and falling. [6]

These are some common premonitory symptoms of apasmara. [7]

Specific types and features of apasmara

Vata dosha dominant apasmara

तत्रेदमपस्मारविशेषविज्ञानं भवति; तद्यथा-

अभीक्ष्णमपस्मरन्तं, क्षणेन सञ्ज्ञां प्रतिलभमानम्, उत्पिण्डिताक्षम्, असाम्नाविलपन्तम्, उद्वमन्तं फेनम्, अतीवाध्मातग्रीवम्, आविद्धशिरस्कं, विषमविनताङ्गुलिम्, अनवस्थितपाणिपादम्, अरुणपरुषश्यावनखनयनवदनत्वचम्, अनवस्थितचपलपरुषरूक्षरूपदर्शिनं, वातलानुपशयं, विपरीतोपशयं च वातेनापस्मरन्तं विद्यात् ||८||

tatrēdamapasmāraviśēṣavijñānaṁ bhavati; tadyathā-

abhīkṣṇamApasmarantaṁ, kṣaṇēna sañjñāṁ pratilabhamānam, utpiṇḍitākṣam, asāmnā vilapantam, udvamantaṁ phēnam, atīvādhmātagrīvam, āviddhaśiraskaṁ, viṣamavinatāṅgulim, anavasthitapāṇipādam, aruṇaparuṣaśyāvanakhanayanavadanatvacam, anavasthitacapalaparuṣarūkṣarūpadarśinaṁ, vātalānupaśayaṁ, viparītōpaśayaṁ ca vātēnāpasmarantaṁ vidyāt (1)||8||

tatredamapasmAravisheShavij~jAnaM bhavati; tadyathA-

abhIkShNamapasmarantaM, kShaNena sa~jj~jAM pratilabhamAnam, utpiNDitAkSham, asAmnA vilapantam, udvamantaM phenam,atIvAdhmAtagrIvam, AviddhashiraskaM, viShamavinatA~ggulim, anavasthitapANipAdam,aruNaparuShashyAvanakhanayanavadanatvacam, anavasthitacapalaparuSharUkSharUpadarshinaM,vAtalAnupashayaM, viparItopashayaM ca vAtenApasmarantaM vidyAt (1)||8||

More frequent episodes of apasmara, episodes of instant loss of consciousness and regain it quickly, bulging or rolling up of eyes, incoherent speech, frothy vomit, excessive stiffness of neck, drooping of the head to one side, irregular contraction of fingers, unstable upper and lower limbs, redness, dryness and grayish tint in the nails, eyes, face and skin, apparent vision or perception of unstable, fickle, coarse and dry objects, conditions associated with consuming vata-aggravating diets and alleviation of ailments when subjected to vata-pacifying diets.[8-1]

Pitta-dominant apasmara

अभीक्ष्णमपस्मरन्तं क्षणेन सञ्ज्ञां प्रतिलभमानम्, अवकूजन्तम्, आस्फालयन्तं भूमिं, हरितहारिद्रताम्रनखनयनवदनत्वचं,रुधिरोक्षितोग्रभैरवादीप्तरुषितरूपदर्शिनं, पित्तलानुपशयं,विपरीतोपशयं च पित्तेनापस्मरन्तं विद्यात् ||८||

abhīkṣṇamapasmarantaṁ kṣaṇēna sañjñāṁ pratilabhamānam, avakūjantam, āsphālayantaṁ bhūmiṁ, haritahāridratāmranakhanayanavadanatvacaṁ, rudhirōkṣitōgrabhairavādīptaruṣitarūpadarśinaṁ, pittalānupaśayaṁ,viparītōpaśayaṁ ca pittēnāpasmarantaṁ vidyāt (2)||8||

abhIkShNamapasmarantaM kShaNena sa~jj~jAM pratilabhamAnam, avakUjantam, AsphAlayantaMbhUmiM, haritahAridratAmranakhanayanavadanatvacaM,rudhirokShitograbhairavAdIptaruShitarUpadarshinaM, pittalAnupashayaM,viparItopashayaM capittenApasmarantaM vidyAt (2)||8||

Frequent episodes of apasmara, instant loss of consciousness and regaining it quickly, stertorous breathing, abnormal, dragging-like movement, green, yellow or coppery tint of nails, eyes, face and skin, apparent vision or perception of bleeding, terrifying, horrible, burning and angry looking objects, conditions associated with pitta-aggravating diets and alleviation of ailments when subjected to pitta-pacifying diets [8-2]

Kapha-dominant apasmara

चिरादपस्मरन्तं, चिराच्च सञ्ज्ञां प्रतिलभमानं, पतन्तम्, अनतिविकृतचेष्टं, लालामुद्वमन्तं, शुक्लनखनयनवदनत्वचं,शुक्लगुरुस्निग्धरूपदर्शिनं, श्लेष्मलानुपशयं, विपरीतोपशयं च श्लेष्मणाऽपस्मर-न्तं विद्यात् ||८||

cirādapasmarantaṁ, cirācca sañjñāṁ pratilabhamānaṁ, patantam, anativikr̥tacēṣṭaṁ, lālāmudvamantaṁ, śuklanakhanayanavadanatvacaṁ, śuklagurusnigdharūpadarśinaṁ, ślēṣmalānupaśayaṁ, viparītōpaśayaṁ ca ślēṣmaṇā'pasmarantaṁ vidyāt (3)||8||

cirAdapasmarantaM, cirAcca sa~jj~jAM pratilabhamAnaM, patantam, anativikRutaceShTaM,lAlAmudvamantaM, shuklanakhanayanavadanatvacaM, shuklagurusnigdharUpadarshinaM,shleShmalAnupashayaM, viparItopashayaM ca shleShmaNA~apasmarantaM vidyAt (3)||8||

Less frequent episodes of apasmara, gradual loss and regain of consciousness, frequently falling down, less pronounced abnormalities in movement, dribbling of saliva, whitish discoloration of nails, eyes, face, and skin, apparent vision or perception of white, heavy and unctuous objects, and conditions associated with consuming kapha-aggravating diets and alleviation of ailments when subjected to kapha-pacifying diets [8-3]

Sannipatika apasmara with dominance of all dosha

समवेतसर्वलिङ्गमपस्मारं सान्निपातिकं विद्यात्, तमसाध्यमाचक्षते इति चत्वारोऽपस्मारा व्याख्याताः ||८||

samavētasarvaliṅgamapasmāraṁ sānnipātikaṁ vidyāt, Tamasādhyamācakṣatē ||

iti catvārō'pasmārā vyākhyātāḥ||8||

samavetasarvali~ggamapasmAraM sAnnipAtikaM vidyAt, tamasAdhyamAcakShate (4)

iti catvAro~apasmArA vyAkhyAtAH||8||

Sannipatika apasmara (caused by the simultaneous vitiation of all the three doshas) shares the symptoms of all the three doshas (described above). This condition is incurable.

Thus, four types of apasmara are explained. [8-4]

apasmara with extrinsic factors

तेषामागन्तुरनुबन्धो भवत्येव कदाचित्, तमुत्तरकालमुपदेक्ष्यामः |

तस्य विशेषविज्ञानं यथोक्तलिङ्गैर्लिङ्गाधिक्यमदोषलिङ्गानुरूपं च किञ्चित् ||९||

tēṣāmāganturanubandhō bhavatyēva kadācit, tamuttarakālamupadēkṣyāmaḥ|

tasya viśēṣavijñānaṁ yathōktaliṅgairliṅgādhikyamadōṣaliṅgānurūpaṁ ca kiñcit||9||

teShAmAganturanubandho bhavatyeva kadAcit, tamuttarakAlamupadekShyAmaH|

tasya visheShavij~jAnaM yathoktali~ggairli~ggAdhikyamadoShali~ggAnurUpaM ca ki~jcit||9||

Sometimes these conditions are associated with extrinsic causative factors described later (in Cikitsa10:53). The symptoms that manifest in such cases, though, are not the same as those caused by vitiated doshas. [9]

Management of apasmara

हितान्यपस्मारिभ्यस्तीक्ष्णानि संशोधनान्युपशमनानि च यथास्वं, मन्त्रादीनि चागन्तुसंयोगे ||१०||

hitānyapasmāribhyastīkṣṇāni saṁśōdhanānyupaśamanāni ca yathāsvaṁ, mantrādīni cāgantusaṁyōgē||10||

hitAnyapasmAribhyastIkShNAni saMshodhanAnyupashamanAni ca yathAsvaM, mantrAdInicAgantusaMyoge||10||

Strong elimination and alleviation therapies are effective in alleviating and curing apasmara. When extrinsic causative factors are involved, then mantras etc., are considered useful. [10]

Manifestation of various diseases

तस्मिन् हि दक्षाध्वरध्वंसे देहिनां नानादिक्षु विद्रवतामभिद्रवणतरणधावनप्लवनलङ्घनाद्यैर्देहविक्षोभणैः पुरागुल्मोत्पत्तिरभूत्, हविष्प्राशात् प्रमेहकुष्ठानां, भयत्रासशोकैरुन्मादानां, विविधभूताशुचिसंस्पर्शादपस्माराणां, ज्वरस्तु खलुमहेश्वरललाटप्रभवः , तत्सन्तापाद्रक्तपित्तम्, अतिव्यवायात् पुनर्नक्षत्रराजस्य राजयक्ष्मेति ||११||

tasmin hi dakṣādhvaradhvaṁsē dēhināṁ nānādikṣu vidravatāmabhidravaṇataraṇadhāvanaplavanalaṅghanādyairdēhavikṣōbhaṇaiḥ purā gulmōtpattirabhūt, haviṣprāśāt pramēhakuṣṭhānāṁ, bhayatrāsaśōkairunmādānāṁ, vividhabhūtāśucisaṁsparśādapasmārāṇāṁ, jvarastu khalu mahēśvaralalāṭaprabhavaḥ , tatsantāpādraktapittam, ativyavāyāt punarnakṣatrarājasya rājayakṣmēti||11||

tasmin hi dakShAdhvaradhvaMse dehinAM nAnAdikShuvidravatAmabhidravaNataraNadhAvanaplavanala~gghanAdyairdehavikShobhaNaiH purAgulmotpattirabhUt, haviShprAshAt pramehakuShThAnAM, bhayatrAsashokairunmAdAnAM,vividhabhUtAshucisaMsparshAdapasmArANAM, jvarastu khalu maheshvaralalATaprabhavaH ,tatsantApAdraktapittam, ativyavAyAt punarnakShatrarAjasya rAjayakShmeti||11||

As per vedic legends, in the aftermath of destruction of Daksha’s yajna (holy sacrifice), gulma (disease similar to lumps in abdomen) was manifested first in human beings due to stress induced as a result of fleeing, swimming, running, flying, etc. in all directions. Prameha (disease of obstinate urinary disorders) and kushtha (obstinate skin diseases including leprosy) were manifested due to excess intake of ghee. Various types of unmada (insanity/psychosis) were manifested due to fear, apprehension and grief. apasmara (epilepsy) set in due to coming in contact with various types of unclean objects. Jwara'' came out of the forehead of Lord Shiva, and raktapitta was manifested (a condition characterized by bleeding from different parts of the body) due to jwara’s heat. Moon was afflicted with rajayakshma due to excessive sexual indulgence. [11]

Summary

भवन्ति चात्र-

अपस्मारो हि वातेन पित्तेन च कफेन च |

चतुर्थः सन्निपातेन प्रत्याख्येयस्तथाविधः ||१२||

साध्यांस्तु भिषजः प्राज्ञाः साधयन्ति समाहिताः |

तीक्ष्णैः संशोधनैश्चैव यथास्वं शमनैरपि ||१३||

यदा दोषनिमित्तस्य भवत्यागन्तुरन्वयः |

तदा साधारणं कर्म प्रवदन्ति भिषग्विदः ||१४||

bhavanti cātra-

apasmārō hi vātēna pittēna ca kaphēna ca|

caturthaḥ sannipātēna pratyākhyēyastathāvidhaḥ||12||

sādhyāṁstu bhiṣajaḥ prājñāḥ sādhayanti samāhitāḥ|

tīkṣṇaiḥ saṁśōdhanaiścaiva yathāsvaṁ śamanairapi||13||

yadā dōṣanimittasya bhavatyāganturanvayaḥ|

tadā sādhāraṇaṁ karma pravadanti bhiṣagvidaḥ||14||

bhavanti cAtra- apasmAro hi vAtena pittena ca kaphena ca|

caturthaH sannipAtena pratyAkhyeyastathAvidhaH||12||

sAdhyAMstu bhiShajaH prAj~jAH sAdhayanti samAhitAH|

tIkShNaiH saMshodhanaishcaiva yathAsvaM shamanairapi||13||

yadA doShanimittasya bhavatyAganturanvayaH|

tadA sAdhAraNaM karma pravadanti bhiShagvidaH||14||

From the preceding verses, it can be said that apasmara manifests itself due to the vitiation of vata, pitta and kapha and sannipata (combined vitiation of all the three doshas). The sannipata variation is incurable. [12]

The curable types of apasmara should be carefully treated by a physician possessing extensive knowledge and experience of administering elimination and alleviation therapies associated with the dosha(s) causing the specific variant of apasmara. [13]

When apasmara is caused by the vitiation of doshas associated with extrinsic causative factors, then general therapies addressing both (doshic equilibrium and extrinsic causes) are advised by the best of physicians. [14]

सर्वरोगविशेषज्ञः सर्वौषधविशारदः|

भिषक् सर्वामयान् हन्ति न च मोहं निगच्छति ||१५||

sarvarōgaviśēṣajñaḥ sarvauṣadhaviśāradaḥ|

bhiṣak sarvāmayān hanti na ca mōhaṁ nigacchati ||15||

sarvarogavisheShaj~jaH sarvauShadhavishAradaH|

bhiShak sarvAmayAn hanti na ca mohaM nigacchati ||15||

An able physician, well versed in the specific characteristics of all diseases and the properties of all medicines, cures all (curable) diseases and does not get confused. [15]

इत्येतदखिलेनोक्तं निदानस्थानमुत्तमम् |१६|

ityētadakhilēnōktaṁ nidānasthānamuttamam|16|

ityetadakhilenoktaM nidAnasthAnamuttamam|16|

This concludes the (excellent section titled) Nidana Sthana. [16]

Diagnostic principles of diseases

Nidanarthakara roga (disease specific causes)

निदानार्थकरो रोगो रोगस्याप्युपलभ्यते ||१६||

nidānārthakarō rōgō rōgasyāpyupalabhyatē||16||

nidAnArthakaro rogo rogasyApyupalabhyate||16||

Diseases can act as causative factors of other diseases as well [16]

तद्यथा-

ज्वरसन्तापाद्रक्तपित्तमुदीर्यते |

रक्तपित्ताज्ज्वरस्ताभ्यां शोषश्चाप्युपजायते ||१७||

tadyathā-

jvarasantāpādraktapittamudīryatē|

raktapittājjvarastābhyāṁ śōṣaścāpyupajāyatē ||17||

tadyathA -

jvarasantApAdraktapittamudIryate|

raktapittAjjvarastAbhyAM shoShashcApyupajAyate ||17||

For example, elevated temperature in jwara can cause raktapitta and raktapitta can cause jwara. Both the diseases (i.e jwara and raktapitta) may lead to shosha (depletion of dhatus). [17]

प्लीहाभिवृद्ध्या जठरं जठराच्छोथ एव च |

अर्शोभ्यो जठरं दुःखं गुल्मश्चाप्युपजायते ||१८||

plīhābhivr̥ddhyā jaṭharaṁ jaṭharācchōtha ēva ca|

arśōbhyō jaṭharaṁ duḥkhaṁ gulmaścāpyupajāyatē||18||

plIhAbhivRuddhyA jaTharaM jaTharAcchotha eva ca|

arshobhyo jaTharaM duHkhaM gulmashcApyupajAyate||18||

Pleeha (enlargement of spleen) causes jathara (abdominal diseases including ascitis), which leads to shotha (generalized edema). Arsha (hemorrhoids) causes jathara (abdominal diseases including ascitis) that leads to gulma (abdominal lumps). [18]

प्रतिश्यायाद्भवेत् कासः कासात् सञ्जायते क्षयः |

क्षयो रोगस्य हेतुत्वे शोषस्याप्युपलभ्यते ||१९||

pratiśyāyādbhavēt kāsaḥ kāsāt sañjāyatē kṣayaḥ|

kṣayō rōgasya hētutvē śōṣasyāpyupalabhyatē||19||

pratishyAyAdbhavet kAsaH kAsAt sa~jjAyate kShayaH|

kShayo rogasya hetutve shoShasyApyupalabhyate||19||

Pratishyaya (rhinitis) leads to kasa (cough) which further leads to kshaya (depletion of dhatu), consequently resulting in sosha (emaciation). [19]

ते पूर्वं केवला रोगाः पश्चाद्धेत्वर्थकारिणः |

उभयार्थकरा दृष्टास्तथैवैकार्थकारिणः [१] ||२०||

tē pūrvaṁ kēvalā rōgāḥ paścāddhētvarthakāriṇaḥ|

ubhayārthakarā dr̥ṣṭāstathaivaikārthakāriṇaḥ [1] ||20||

te pUrvaM kevalA rogAH pashcAddhetvarthakAriNaH|

ubhayArthakarA dRuShTAstathaivaikArthakAriNaH ||20||

Conditions in their primary stages or forms manifest themselves as diseases and subsequently act as causative factors for other diseases. They thus play a dual role - as a disease and as a causative factor. Some of these play just one role as well– either as a disease or as a causative factor. [20]

कश्चिद्धि रोगो रोगस्य हेतुर्भूत्वा प्रशाम्यति |

न प्रशाम्यति चाप्यन्यो हेत्वर्थं कुरुतेऽपि च ||२१||

kaściddhi rōgō rōgasya hēturbhūtvā praśāmyati|

na praśāmyati cāpyanyō hētvarthaṁ kurutē'pi ca||21||

kashciddhi rogo rogasya heturbhUtvA prashAmyati|

na prashAmyati cApyanyo hetvarthaM kurute~api ca ||21||

Some diseases subside after causing another disease, while some do not subside even after causing another disease. [21]

एवं कृच्छ्रतमा नॄणां दृश्यन्ते व्याधिसङ्कराः |

प्रयोगापरिशुद्धत्वात्तथा चान्योन्यसम्भवात् ||२२||

ēvaṁ kr̥cchratamā nr̥̄ṇāṁ dr̥śyantē vyādhisaṅkarāḥ|

prayōgāpariśuddhatvāttathā cānyōnyasambhavāt||22||

evaM kRucchratamA nRUNAM dRushyante vyAdhisa~gkarAH|

prayogAparishuddhatvAttathA cAnyonyasambhavAt||22||

Combinations of diseases in human beings are usually very difficult to treat, owing to the complexity of the line of treatment, and their serving as causative factors of each other. [22]

Ideal therapy without adverse effects

प्रयोगः शमयेद्व्याधिं योऽन्यमन्यमुदीरयेत् |

नासौ विशुद्धः, शुद्धस्तु शमयेद्यो न कोपयेत् ||२३||

prayōgaḥ śamayēdvyādhiṁ yō'nyamanyamudīrayēt|

nāsau viśuddhaḥ, śuddhastu śamayēdyō na kōpayēt||23||

prayogaH shamayedvyAdhiM yo~anyamanyamudIrayet|

nAsau vishuddhaH, shuddhastu shamayedyo na kopayet||23||

A therapy that alleviates one disease condition but provokes another disease is not shuddha (or is an impure or incorrect therapy). The ideal therapy is that which pacifies a disease without provoking any other disease. [23]

Diagnostic aspect of etiological factors

एको हेतुरनेकस्य तथैकस्यैक एव हि |

व्याधेरेकस्य चानेको बहूनां बहवोऽपि च ||२४||

ēkō hēturanēkasya tathaikasyaika ēva hi|

vyādhērēkasya cānēkō bahūnāṁ bahavō'pi ca||24||

eko heturanekasya tathaikasyaika eva hi|

vyAdherekasya cAneko bahUnAM bahavo~api ca||24||

One causative factor may cause one or many diseases. Many causative factors may result in a single disease or may cause several diseases. [24]

ज्वरभ्रमप्रलापाद्या दृश्यन्ते रूक्षहेतुजाः |

रूक्षेणैकेन चाप्येको ज्वर एवोपजायते ||२५||

jvarabhramapralāpādyā dr̥śyantē rūkṣahētujāḥ|

rūkṣēṇaikēna cāpyēkō jvara ēvōpajāyatē||25||

jvarabhramapralApAdyA dRushyante rUkShahetujAH|

rUkSheNaikena cApyeko jvara evopajAyate||25||

It is seen that a single causative factor, ruksha (dry) can cause many diseases such as jwara (fever), bhrama (vertigo) and pralapa (delirium) etc., while the same single factor (ruksha) may cause just one disease (jwara) [25]

हेतुभिर्बहुभिश्चैको ज्वरो रूक्षादिभिर्भवेत् |

रूक्षादिभिर्ज्वराद्याश्च व्याधयः सम्भवन्ति हि ||२६||

hētubhirbahubhiścaikō jvarō rūkṣādibhirbhavēt|

rūkṣādibhirjvarādyāśca vyādhayaḥ sambhavanti hi||26||

hetubhirbahubhishcaiko jvaro rUkShAdibhirbhavet|

rUkShAdibhirjvarAdyAshca vyAdhayaH sambhavanti hi||26||

Jwara alone may be caused by a combination of several causative factors including but not limited to ruksha(dry) etc. and many causes like, ruksha (dry, rough) etc. may lead to several diseases. [26]

Diagnostic aspect of symptoms

लिङ्गं चैकमनेकस्य तथैवैकस्य लक्ष्यते |

बहून्येकस्य च व्याधेर्बहूनां स्युर्बहूनि च ||२७||

liṅgaṁ caikamanēkasya tathaivaikasya lakṣyatē|

bahūnyēkasya ca vyādhērbahūnāṁ syurbahūni ca||27||

li~ggaM caikamanekasya tathaivaikasya lakShyate|

bahUnyekasya ca vyAdherbahUnAM syurbahUni ca||27||

Similarly, one symptom may be common to many diseases, one symptom may be related to only one disease, many symptoms may be associated with only one disease, and many symptoms may be common to many diseases. [27]

विषमारम्भमूलानां लिङ्गमेकं ज्वरो मतः |

ज्वरस्यैकस्य चाप्येकः सन्तापो लिङ्गमुच्यते ||२८||

viṣamārambhamūlānāṁ liṅgamēkaṁ jvarō mataḥ|

jvarasyaikasya cāpyēkaḥ santāpō liṅgamucyatē||28||

viShamArambhamUlAnAM li~ggamekaM jvaro mataH|

jvarasyaikasya cApyekaH santApo li~ggamucyate||28||

One symptom i.e. jwara can be considered common to many diseases that have irregular onset, while santapa (elevated temperature) is considered a symptom of only one disease i.e. jwara.[28]

विषमारम्भमूलैश्च ज्वर एको निरुच्यते |

लिङ्गैरेतैर्ज्वरश्वासहिक्काद्याः सन्ति चामयाः ||२९||

viṣamārambhamūlaiśca jvara ēkō nirucyatē|

liṅgairētairjvaraśvāsahikkādyāḥ santi cāmayāḥ||29||

viShamArambhamUlaishca jvara eko nirucyate|

li~ggairetairjvarashvAsahikkAdyAH santi cAmayAH||29||

Irregular onset (and similar other symptoms) appear in the case of jwara, while similar symptoms also occur in shwasa (dyspnea), hikka (hiccups), and other similar diseases. [29]

Therapeutic considerations

एका शान्तिरनेकस्य तथैवैकस्य लक्ष्यते |

व्याधेरेकस्य चानेका बहूनां बह्व्य एव च ||३०||

ēkā śāntiranēkasya tathaivaikasya lakṣyatē|

vyādhērēkasya cānēkā bahūnāṁ bahvya ēva ca||30||

ekA shAntiranekasya tathaivaikasya lakShyate|

vyAdherekasya cAnekA bahUnAM bahvya eva ca||30||

A single therapy can subside many diseases as well as a single disease. Multiple therapies may be needed to subside many diseases, whereas one disease could require multiple therapies to cure. [30]

शान्तिरामाशयोत्थानां व्याधीनां लङ्घनक्रिया |

ज्वरस्यैकस्य चाप्येका शान्तिर्लङ्घनमुच्यते ||३१||

śāntirāmāśayōtthānāṁ vyādhīnāṁ laṅghanakriyā|

jvarasyaikasya cāpyēkā śāntirlaṅghanamucyatē||31||

shAntirAmAshayotthAnAM vyAdhInAM la~gghanakriyA|

jvarasyaikasya cApyekA shAntirla~gghanamucyate||31||

The diseases originating from amashaya are cured by langhana (fasting), only whereas only a single disease entity jwara also can be treated by the single therapy of langhana (fasting). [31]

तथा लघ्वशनाद्याश्च ज्वरस्यैकस्य शान्तयः |

एताश्चैव ज्वरश्वासहिक्कादीनां प्रशान्तयः ||३२||

tathā laghvaśanādyāśca jvarasyaikasya śāntayaḥ|

ētāścaiva jvaraśvāsahikkādīnāṁ praśāntayaḥ||32||

tathA laghvashanAdyAshca jvarasyaikasya shAntayaH|

etAshcaiva jvarashvAsahikkAdInAM prashAntayaH||32||

For treating a single disease like jwara, multiple therapies like light diet, etc. are needed and the same multiple therapies like light diet etc. are needed to subside many diseases like jwara(fever), shwasa(dyspnea), hikka(hiccups) etc. [32]

Prognostic aspect in therapy

सुखसाध्यः सुखोपायः कालेनाल्पेन साध्यते |

साध्यते कृच्छ्रसाध्यस्तु यत्नेन महता चिरात् ||३३||

याति नाशेषतां व्याधिरसाध्यो याप्यसञ्ज्ञितः |

परोऽसाध्यः क्रियाः सर्वाः प्रत्याख्येयोऽतिवर्तते ||३४||

नासाध्यः साध्यतां याति साध्यो याति त्वसाध्यताम् |

पादापचाराद्दैवाद्वा यान्ति भावान्तरं गदाः ||३५||

sukhasādhyaḥ sukhōpāyaḥ kālēnālpēna sādhyatē|

sādhyatē kr̥cchrasādhyastu yatnēna mahatā cirāt||33||

yāti nāśēṣatāṁ vyādhirasādhyō yāpyasañjñitaḥ|

parō'sādhyaḥ kriyāḥ sarvāḥ pratyākhyēyō'tivartatē||34||

nāsādhyaḥ sādhyatāṁ yāti sādhyō yāti tvasādhyatām|

pādāpacārāddaivādvā yānti bhāvāntaraṁ gadāḥ||35||

sukhasAdhyaH sukhopAyaH kAlenAlpena sAdhyate|

sAdhyate kRucchrasAdhyastu yatnena mahatA cirAt||33||

yAti nAsheShatAM vyAdhirasAdhyo yApyasa~jj~jitaH|

paro~asAdhyaH kriyAH sarvAH pratyAkhyeyo~ativartate||34||

nAsAdhyaH sAdhyatAM yAti sAdhyo yAti tvasAdhyatAm|

pAdApacArAddaivAdvA yAnti bhAvAntaraM gadAH||35||

Easily curable diseases can be managed in a short time by simple measures. Diseases which are difficult to cure may require more effort and time to cure. The palliable variety of incurable diseases can never be cured, but can be alleviated. Incurable diseases are not amenable to any type of treatment.

Conversely, incurable diseases never become curable, while the curable varieties may become incurable due to factors like incompetence of the four components of health management (the physician, the medicine, the attendant and the patient) and/or misfortune. The easily curable kinds may also become difficult to cure, if not incurable, while diseases that are difficult to cure may become palliable and palliable variety may become incurable. [33-35]

Examination of stages of disease

वृद्धिस्थानक्षयावस्थां रोगाणामुपलक्षयेत् |

सुसूक्ष्मामपि च प्राज्ञो देहाग्निबलचेतसाम् ||३६||

vr̥ddhisthānakṣayāvasthāṁ rōgāṇāmupalakṣayēt |

susūkṣmāmapi ca prājñō dēhāgnibalacētasām||36||

vRuddhisthAnakShayAvasthAM rogANAmupalakShayet |

susUkShmAmapi ca prAj~jo dehAgnibalacetasAm||36||

A wise physician should carefully observe the subtle changes in the state of diseases (aggravated, normal and diminished) while properly assessing the patient’s body strength, digestive power and mental ability. [36]

व्याध्यवस्थाविशेषान् हि ज्ञात्वा ज्ञात्वा विचक्षणः |

तस्यां तस्यामवस्थायां चतुःश्रेयः प्रपद्यते ||३७||

vyādhyavasthāviśēṣān hi jñātvā jñātvā vicakṣaṇaḥ|

tasyāṁ tasyāmavasthāyāṁ catuḥśrēyaḥ prapadyatē||37||

vyAdhyavasthAvisheShAn hi j~jAtvA j~jAtvA vicakShaNaH|

tasyAM tasyAmavasthAyAM catuHshreyaH prapadyate||37||

The physician, who is keenly observing variations in disease stages in the patient, should know it (the disease) well and prescribe such a treatment that would be helpful in attaining the fourfold effect of therapeutics. [37]

प्रायस्तिर्यग्गता दोषाः क्लेशयन्त्यातुरांश्चिरम् |

तेषु न त्वरया कुर्याद्देहाग्निबलवित् क्रियाम् ||३८||

प्रयोगैः क्षपयेद्वा तान् सुखं वा कोष्ठमानयेत् |

ज्ञात्वा कोष्ठप्रपन्नांस्तान् यथासन्नं हरेद्बुधः ||३९||

prāyastiryaggatā dōṣāḥ klēśayantyāturāṁściram|

tēṣu na tvarayā kuryāddēhāgnibalavit kriyām||38||

prayōgaiḥ kṣapayēdvā tān sukhaṁ vā kōṣṭhamānayēt|

jñātvā kōṣṭhaprapannāṁstān yathāsannaṁ harēdbudhaḥ||39||

prAyastiryaggatA doShAH kleshayantyAturAMshciram|

teShu na tvarayA kuryAddehAgnibalavit kriyAm||38||

prayogaiH kShapayedvA tAn sukhaM vA koShThamAnayet|

j~jAtvA koShThaprapannAMstAn yathAsannaM haredbudhaH||39||

Generally, doshas that are spread over obliquely (in the transverse direction) afflict the patient for a longer time. In that condition, treatment should not be initiated in a hurry without proper assessment of body strength and digestive power. These doshas should be alleviated first by treatment, or they should be carefully be drawn to the koshtha (bowel). After knowing their status in koshtha, the wise physician should eliminate them through the nearest route. [38-39]

ज्ञानार्थं यानि चोक्तानि व्याधिलिङ्गानि सङ्ग्रहे |

व्याधयस्ते तदात्वे तु लिङ्गानीष्टानि नामयाः ||४०||

jñānārthaṁ yāni cōktāni vyādhiliṅgāni saṅgrahē|

vyādhayastē tadātvē tu liṅgānīṣṭāni nāmayāḥ||40||

j~jAnArthaM yAni coktAni vyAdhili~ggAni sa~ggrahe|

vyAdhayaste tadAtve tu li~ggAnIShTAni nAmayAH||40||

In the Nidana Sthana, a compendium of symptomatology has been provided as a reckoner for the Ayurveda practitioner to gain adequate knowledge of some of the major classes of diseases and diagnose them effectively. But these symptoms may independently develop into diseases and create emergency situations. [40]

विकारः प्रकृतिश्चैव द्वयं सर्वं समासतः |

तद्धेतुवशगं हेतोरभावान्नानुवर्तते ||४१||

vikāraḥ prakr̥tiścaiva dvayaṁ sarvaṁ samāsataḥ|

taddhētuvaśagaṁ hētōrabhāvānnānuvartatē||41||

vikAraH prakRutishcaiva dvayaM sarvaM samAsataH|

taddhetuvashagaM hetorabhAvAnnAnuvartate||41||

Everything can be categorized into being in a normal or an abnormal state. Both of these categories depend upon causes. Nothing can happen without a cause. [41]

Summary

तत्र श्लोकाः-

हेतवः पूर्वरूपाणि रूपाण्युपशयस्तथा |

सम्प्राप्तिः पूर्वमुत्पत्तिः सूत्रमात्रं चिकित्सितात् ||४२||

ज्वरादीनां विकाराणामष्टानां साध्यता न च |

पृथगेकैकशश्चोक्ता हेतुलिङ्गोपशान्तयः ||४३||

हेतुपर्यायनामानि व्याधीनां लक्षणस्य च |

निदानस्थानमेतावत् सङ्ग्रहेणोपदिश्यते ||४४||

tatra ślōkāḥ-

hētavaḥ pūrvarūpāṇi rūpāṇyupaśayastathā|

samprāptiḥ pūrvamutpattiḥ sūtramātraṁ cikitsitāt||42||

jvarādīnāṁ vikārāṇāmaṣṭānāṁ sādhyatā na ca|

pr̥thagēkaikaśaścōktā hētuliṅgōpaśāntayaḥ||43||

hētuparyāyanāmāni vyādhīnāṁ lakṣaṇasya ca|

nidānasthānamētāvat saṅgrahēṇōpadiśyatē||44||

tatra shlokAH-

hetavaH pUrvarUpANi rUpANyupashayastathA|

samprAptiH pUrvamutpattiH sUtramAtraM cikitsitAt||42||

jvarAdInAM vikArANAmaShTAnAM sAdhyatA na ca|

pRuthagekaikashashcoktA hetuli~ggopashAntayaH||43||

hetuparyAyanAmAni vyAdhInAM lakShaNasya ca|

nidAnasthAnametAvat sa~ggraheNopadishyate||44||

To sum up this chapter, etiological factors, premonitory symptoms, signs and symptoms, therapeutic relief, pathogenesis, historical origins and brief line of treatment of apasmara have been described in this section. Since this is the concluding chapter of the Nidana Sthana, a summary to the entire section has also been provided here, stating that starting from jwara all eight diseases have been dealt with separately in eight chapters, each with etiological factors, symptomatology, prognosis and brief line of management.

A compendium of diseases with etiological factors, their synonyms, symptoms of the diseases have been provided as an epilogue to the chapter. [42-44]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने अपस्मारनिदानं नामाष्टमोऽध्यायः |

निदानस्थानं समाप्तम् ||८||

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē

apasmāranidānaṁ nāmāṣṭamō'dhyāyaḥ||8||

iti carakasaṁhitāyāṁ dvitīyaṁ nidānasthānaṁ samāptam|


Thus, ends the eighth chapter on the ‘diagnosis of apasmara” of the section “Diagnosis of diseases” (Nidana Sthana) of Agnivesha , as redacted by Charak.

Tattva Vimarsha (Fundamental Principles)

  • Apasmara is a disease due to vitiation of three sharira doshas and two manas doshas.
  • The causative factors of apasmara mainly include consuming unhygienic, impure, decomposed food and encountering inauspicious things that are not compatible with one’s sensibilities.
  • Diet is important for sustaining physical and psychological health. Improper dietary habits can lead to various psychosomatic disorders associated with apasmara.
  • Apasmara originates from the heart, which is the center of consciousness and emotions per Vedic texts. The clinical presentation includes impaired heart-brain coordination leading to transient loss of memory, erratic movements, and blackouts. Analysis of the heart-brain connection is very important in the pathology of apasmara.
  • Psychological stressors like excessive passion, anger, fear, greed, attachment, excitement, grief, anxiety, worry, perturbation etc. precipitate episodes of apasmara in a person afflicted with excessively aggravated dosha.
  • apasmara, depending upon the predominant dosha, can be diagnosed on the basis of frequency of episodes, duration of loss of consciousness, pattern of abnormal movements, and types of objects perceived (in aura phase) prior to the occurrence of an actual episode.
  • Purification therapies using strong medicines, observing a healthy diet and lifestyle are considered the primary forms of treatment of apasmara. Non-pharmacological measures like mantra (holy chants) and sattvavajaya chikitsa (mind training for restraint, such as cognitive behavior therapy) aid in the treatment of apasmara.
  • There can be one causative factor for many diseases or multiple causative factors for single disease.
  • Similarly one symptom can be common in many diseases and one symptom can be seen in a single disease alone.
  • There could be a single treatment for many diseases or many treatments for a single disease.
  • The duration of treatment depends upon prognosis of the disease. A disease at the onset may be curable but if not treated, could worsen into a palliable or incurable variant.
  • The subtle changes in dosha, and the three states of a disease (aggravated, normal, or diminished) should be carefully observed along with proper assessment of body strength, digestive power and mental ability .
  • The doshas that spread obliquely (in the transverse direction) afflict patient for a longer time. These doshas should be managed first, or they should be carefully drawn to koshtha (bowel) by proper measures. After analyzing them in koshtha, the physician should eliminate them through the nearest route.

Vidhi Vimarsha (Applied Inferences)

The chapter on apasmara is sequenced after the one on unmada. The sequence is due to similarities of clinical origin as well as causative and pathophysiological factors, since both diseases are psychosomatic in nature.

History and origin of the disease in ancient medical literature

The origin of various diseases is narrated in the eleventh verse of the chapter. apasmara originates from physical and mental contact with various unclean and unwholesome exogenous factors leading to imbalance at physical and psychological levels. The words ashuchi samsparsha literally mean direct contact of body and mind with unwholesome things. This is further supported by apasmara’s etiology which points at improper diet and lifestyle as a major causative factor.

Review of ancient medical literature confirms that epilepsy was initially called sacred, because of the belief for its divine origin[3]. A chapter on epilepsy in Babylonian texts on medicine comprising 40 tablets dating as far back as 1067 BC accurately recorded many of the different seizure types recognized today. It emphasizes upon the supernatural nature of epilepsy, with each seizure type associated with a divinity, spirit or deity (usually evil)[4]. It was believed, in antiquity, that if a person comes in contact with things that are supernatural and evil, he/she would suffer from epilepsy. This view is consistent with those in ancient Greek, British, and Indian (Vedic) literature as well. The Ayurvedic theory of origin of epilepsy mentions contact with evil, unwholesome and unclean objects or experiences as key causative factors. References of grahas (celestial bodies) as a causative factor of apasmara, specifically in children, can be found in vedic texts with terms such as ‘skanda’ and ‘skandapasmara. Though there are references of exogenous variants of epilepsy (agantu apasmara) in Charak Samhita, a detailed description of these is not found. This indicates two things:

  1. Epilepsy originates from exposure to unwholesome, unclean and evil things either at a physical or at a psycho-spiritual plane.
  2. Management of the disease may include adhyatmik chikitsa (psycho-spiritual therapy) for better treatment.

Definition of apasmara

apasmara is defined as the occasional loss of consciousness due to deterioration of smriti (memory), buddhi (intellect) and sattva (mind), characterized by tamahpravesha (entering darkness/ blackouts) and bibhatsa cheshta (abnormal movements).

As explained by Sushruta, smriti in context of apasmara is bhutarha vijnana i.e. orientation of external world and consciousness. Dhi-buddhi (intellect) is karya-akarya vibhaga karini i.e. discriminating power between right and wrong. Sattva is referred as manas (mind) and dhairya (temperance, patience). A patient of apasmara suffers from deterioration of all these three important mental faculties (dhi, buddhi and smriti).

The first cardinal sign of this deterioration is tamapravesha , i.e., jnana abhava or loss of knowledge and the ability to acquire new knowledge. The second cardinal sign, bibhatsa cheshta, indicates involuntary movements of body due to lack of brain’s control or improper coordination. Sushruta narrated that due to these features of apasmara, the disease often leads to death (antakrita). Dallhana comments that the dreadfulness of this disease is due to the fact that an afflicted person may fall into water or fire due to lack of orientation.

Impairment of knowledge and coordination

 
Fig. 1: Faculty involved in attainment of knowledge

According to Ayurveda, knowledge of external objects is processed through sense organs , to the mind-intellect, culminating in the spirit. This chain or sequence for attainment of knowledge is important for proper functioning of memory (encoding, storage and retrieval) and intellect (cognition) [Fig.1]. Occasional impairment of coordination in the sequence consisting of sense organs-intellect-mind-spirit is seen in apasmara. This may lead to decrease in cognitive performance of an individual.[Fig. 1: Faculty involved in attainment of knowledge]

In conventional medicine, three major factors that cause disturbance in cerebral neurotransmission leading to blackouts and epilepsy viz. hypo-perfusion, hypo-metabolism, and hypoxia have been described in relevant medical texts. These disturbances lead to abnormal discharges, improper signal transduction in the neurotransmitter channels, and seizures. As a consequence, cellular dysfunctions in the brain, disruptions of the memory mechanism, and disturbed coordination of movements may occur causing the clinical manifestation of apasmara. The role of these three factors and its impact on memory and cellular dysfunction in the pathogenesis of epilepsy need to be elucidated. The three pathological effects are comparable to the changes created by vitiation of kapha, pitta and vata. Differentiation between these three types of manifestations is described further.

Per Ayurveda, smriti is atmaja (originated from the soul) and sattvaja (originated from the mind). This means that smriti (memory) of a person is essentially related with soul and mind. The Bhagavad Gita describes the consequences of excessive indulgence in sensory activities leading to excessive affliction resulting in an increase in passion, then anger, and then lack of knowledge. This further leads to deterioration of smriti and then affecting the intellect. This sequence lays the ground for apasmara.

Tattva Sara

Three factors of mind, memory, intellect and consciousness are impaired in apasmara. Due care should be taken to protect and manage these three. Herbs like medhya rasayana and treatment modalities like sattvajaya chikitsa are known to promote activities of mind, intellect and consciousness.

Predisposing factors for apasmara

The susceptible individuals and conditions for epilepsy are described in detail:

Rajas–tamas affliction

The first factor, rajas - tamas affliction, signifies the role of mind in etio-pathology of apasmara. Rajas is a guna (tendency or attribute) responsible for the initiation of every kind of activity and symbolizes energy, while Tamas is the guna symbolizing inertia, dulling or stopping of activities. These two play an important role in the coordination of activities within the sequence of sense organs-mind-intellect-spirit, in the attainment of knowledge as well as to maintain the orientation of external world (consciousness). A rajas-tamas affliction, therefore, adversely impacts coordination of activities and perverts the mind and intellect, landing the patient into loss of orientation and consciousness. A “distressed” state of mind, caused by rajas-tamas affliction, is an important etiological factor responsible for various psychosomatic disorders such as epilepsy. Therefore, rehabilitating the rajas - tamas balance (and thus, achieving harmony between all the three gunas) is of utmost importance in preventing the pathology and maintenance of health. Neurologically, initiation of action through neurotransmitters such as acetylcholine, while inhibition of action through dopamine can be categorized under rajas and tamas respectively. Synchronization of discharges in the cerebral region is a result of rajas-tamas balance. Disturbance in this rajas-tamas balance and depletion of sattva leads to hypersynchronization, resulting in seizures. Threshold of neuronal activity is due to balance between sattva, rajas and tamas. It is sattva that maintains the normal threshold of neuronal activities. Decreased sattva and/or increased rajas and tamas can alter the threshold of neurons.

The state of mind afflicted due to rajas and tamas can be considered as ‘distressed mind’ observed as important causative factor for various psycho somatic disorders like epilepsy.

Sharira dosha vitiation

The second important factor is imbalance of doshas at the somatic level. There are three terms used to indicate the state of doshas which predisposes apasmara:

  • First is udbhranta (moving upwards in vitiated state). The upward direction of flow of doshas may indicate the pathway of apasmara from the heart to the brain. The pathology starts from the abode of consciousness i.e. heart, spreading upwards afflicting sense organs. In Chikitsa Sthana, the term vibhranta is used to denote this condition.
  • The second state is vishama, meaning a state of disequilibrium. Imbalanced doshas create a favorable environment for apasmara. *The third state is bahu (excessive), meaning that the imbalance is excessive enough to affect the brain-mind system. This suggests that the doshas are in an aggravated state of imbalance and predispose to the disease. The condition also points towards manifestation of apasmara as a result of other somatic disease pathologies.

The disease condition is a result of combination of the above states of doshas with the rajas-tamas affliction. These are sanchaya (accumulation), prakopa (aggravation) and prasara (spread) stages of the disease - important somatic factors for causation of apasmara.

The cumulative presentation suggests the psychosomatic nature of the disease where the psyche and soma are equally involved in the pathogenesis. This is important while treating apasmara, because this indicates that only administering anti-epileptic drugs is not enough in treating apasmara. The treatment of underlying psychological factors shall also be given due emphasis.

Role of diet

The third key factor is the role of quality of diet in the causation of the disease. Charak uses terms like samala (impure), vikrita (deformed/altered), upahita (mixed), and ashuchi (unclean/unhygienic) as adjectives to describe food articles that cause apasmara. Sushruta uses terms like viruddha (incompatible or of contradictory/antagonistic nature) and malina (bad) for the same factors. Besides providing nutrition to the body, diet plays a great impact on the mind as well. It is mentioned in the texts that the nutrition of soma and psyche occurs through food and food habits. Yogic texts narrate the role of food in nourishing five sheaths of the body, called annamaya kosha, pranamaya kosha, vijnanamaya kosha, manomaya kosha and anandmaya kosha. Therefore, diet is not only important for proper functioning of the three doshas, but also for nourishment of the mind and the soul. Charak as well as Sushruta have acknowledged the role of unclean, unhygienic, unwholesome, incompatible diet in the causation of apasmara. Dallhana commented that this includes the diet that is dwishta (disliked by mind or taken with hatred feeling), amedhya (not satisfying mind) and paryushita (stale). All these types of diet can cause disturbance in the body and mind. As per conventional medicine, a diet that is deficient in certain vitamins and minerals and that which increases neurotoxins may lead to neurological disorders. Therefore, biochemical changes in the above mentioned causative foods may lead to deficiencies of important nutrients and cause increase in neurotoxins resulting in apasmara like disorders. Moreover, some gastrointestinal symptoms have been described further as premonitory symptoms of apasmara. The role of diet and food habits as a cause of apasmara needs to be further researched. These factors are to be avoided during the treatment of apasmara. Not following /proper dietary rules is one of the key causes for the formation of ama. Ama produces free radicals leading to excessive oxidative stress and tissue injuries. Therefore, following proper dietary habits is important in preventing the pathogenesis of the disease. Furthermore, this suggests the possibility of food contamination as a causative factor for epilepsy. A case of endrin-laced taquitos causing seizures in the US is an example of food contamination causing epileptic seizures .[5]

Improper methods – lifestyle factors

The fourth etiological factor of epilepsy is not following the prescribed rules of diet and lifestyle. The upayoga vidhi lists improper dietary habits, lifestyle and code of conduct that lead to disturbances in soma and psyche. Sushruta has elaborated the role of incorrect or excessive indulgence in activities of sense organs and locomotor organs as the foremost causative factor for apasmara. This is suggestive of disturbances in the knowledge coordination chain leading to lack of attainment of knowledge. This factor also indicates role of unhealthy regimens and behavior in patho-physiology of epilepsy. The factor underlies ignorance towards proper dinacharya (diurnal regimen), ratricharya (night regimen) and ritucharya (seasonal regimen). The lifestyle and behavior of a person is important for achieving normalcy in the psychic plane and for avoiding psychological disorders. This also suggests the inclusion of prajnaparadha (intellectual blasphemy) described in Sharira Sthana. Achara rasayana (code of conduct) should be followed as a therapeutic regimen in the management of apasmara. The psycho-neuro-biological basis of etiopathological factors causing neurological disorders is being extensively researched with positive outcomes. Psycho-social distress is an important underlying factor for such disorders through impairment of hypothalamo-pituitary-adrenal axis. The preventive measures to be included are correct and productive indulgence in the sensory and locomotor activities as per capacity of an individual. Psychotherapy is believed to be effective in the management of apasmara.

Improper techniques

Observance of improper tantra (techniques/methods) makes the person prone to apasmara and is the fifth causative factor. This includes iatrogenic factors such as improper follow ups of Panchakarma procedures leading to vitiation of doshas in the body. The other meaning of tantra might be related to spiritual practices that are related to the supernatural powers mentioned earlier as reasons for causing epilepsy. Improper use of these tantric therapies can result in epilepsy.

Iatrogenic causes can increase susceptibility to apasmara. Therefore all procedures should be followed properly in order to prevent complications.

Incorrect postures and movements

The sixth etiological factor constitutes of wrong postures and movements. Since the coordination of movements is regulated by dhi-buddhi-smriti, any imbalance in the sense organs-mind-intellect-spirits sequence not only impairs movement of limbs but also increases the propensity of getting afflicted with apasmara. Conversely, wrong postures and movements are a result of disturbances in the sense organs-spirits sequence that lead to incorrect attainment of knowledge with the manifestation of apasmara.

Uncomfortable sitting, sleeping, positioning, irregular, uncoordinated movements of body (e.g. improper dance, sports etc.) can predispose apasmara.

Excessive degeneration and debility

The seventh and last etiological factor i.e. excessive degeneration or debility may lead to pathogenesis of apasmara , pointing at dhatukshayajanya vataprakopa (vitiation of vata due to depletion of tissues) as a root cause. The degeneration might be a secondary condition resulting from other diseases. Hypo-perfusion and low levels of oxygen and metabolism could result in brain cell dysfunctions causing seizures. This is analogous to the concept of ati upakshaya in Ayurveda. Therefore, a clinical examination of depletion of tissues (dhatukshaya) could be considered as a treatment component in the management of apasmara.

Acute and severe electrolyte imbalances (hyponatremia, hypocacemia and hypomagnesemia) frequently cause seizures.

The underlying etiology of other degenerative diseases should be considered while dealing with cases of epilepsy. In that case, management of epilepsy should be supported by proper nutrition, restorative, replenishing and rejuvenation therapies.

Additional factors by Sushruta

In addition to the above factors, Sushruta has quoted two more factors for predisposition of apasmara. Veganigraha sheelanam i.e. habitual suppression of natural urges and gachchatam cha rajaswalam i.e., having sexual intercourse with menstruating women can make the individual more susceptible to epilepsy. Recent research suggests that menotoxins secreted by the female body during menstruation significantly impact the psyche of a person accompanying that female.

On the first of these two factors, per Ayurveda, suppression of any of the thirteen types of natural urges may lead to various disorders. Suppressing natural urges leads to vata-dominant disorders and as vata is the regulator of mind-related activities, this consequently can result in neuropsychiatric disorders like apasmara. All the urges are stimulated, regulated and completed by the nervous system. Inhibition of these factors might lead to impairment of neurotransmission which can be a cause for neuropsychiatric disorders. Furthermore, suppression of urges can lead to accumulation of waste materials inside the body creating various diseases.

On the second factor mentioned here, the correlation between having an intercourse with menstruating women and getting afflicted with epilepsy needs to be researched further. Ayurveda strictly forbids sharing things with a menstruating woman, leave aside touching or having sexual relations with one. While there are reasons of following sacredness associated with this, sex with a menstruating woman is also indicative of exposure to unclean objects described earlier as the origin of apasmara. The psycho-neuro-endocrinological axis behind this view of Sushruta needs to be explored.

Thus, from the above descriptions, etiopathological factors of apasmara can be categorized into dietary factors, lifestyle factors, psychological factors, behavioral factors and iatrogenic factors. All the above predisposing factors can be scanned for epigenetic modifications with respect to personality types, behavior patterns and occurrence of apasmara in such cases. This will be useful in identifying the disease at a primitive stage, breaking the pathogenesis at an intermedial stage and prevention of further deterioration and complications at later stage. There might be certain epigenetic patterns/changes due to the above mentioned etiological factors, which make the person more susceptible to get affected.

The above enlisted etiological factors cause depletion in psychological strength (objectively measured as Intelligence quotient (IQ) and Emotional Quotient (EQ). In the era of distress, it is important to know the etiology of a disease in order to prevent its harmful effects. In order to preserve and increase the psychological strength, one shall avoid the causative factors for apasmara.

 
Fig.2: Psycho-dynamics in Apasmara


Fig.2: Psycho-dynamics in apasmara

Six stages of pathogenesis of epilepsy (shatkriyakala for apasmara)

The pathogenesis of apasamara can be understood as below. [Fig.3: Schematic presentation of pathogenesis of apasmara]

 
Fig.3a: Schematic presentation of pathogenesis of apasmara
 
Fig.3b: Schematic presentation of pathogenesis of apasmara


Sanchaya

The first stage of accumulation of pathogenic factors (vitiated doshas) starts at their own sites. It is initiated right from the first exposure to unclean objects and other etiological factors mentioned earlier. This stage is characterized by mild disturbances in the psyche (rajas and tamas) and soma (tridosha).

Prakopa

If the individual excessively indulges in observing causative factors for a significant period, then the doshas proceed to the next stage of pathology i.e. prakopa. The doshas are vitiated at their own site. In case of apasmara, the doshas reside at the vessels, above the heart (the site of consciousness) in a leena (dormant) state [Cha.Sa.Chikitsa Sthana 10/6].

Prasara

Whenever the provocative emotional factors like worries, passion, anger etc. trigger these doshas, the vitiated dosha moves upwards affecting the sense and locomotor organs. This will present the prasara avastha (stage of spread) of the disease.

Sthanasamshraya

Thereafter in sthanasamshraya avastha of apasmara (change in stage, triggering premonitory signs and symptoms), the stridden doshas take pathways of sense organs and locomotor organs alerting manifestation of the disease. This is called the aura stage of epilepsy.

Vyakta

Then, the vyakta i.e. manifestation stage of apasmara is apparent due to excessive aggravation of doshas. The severity of paroxysms depends upon sharira bala (physical strength that helps do physical work as well as prevent manifestations of diseases, includes genetic predisposition as well), hetu (strength of causative agents depending upon their exposure) and sattva bala (strength of mind). The clinical manifestation will be a product of interactions between these factors. Common clinical features of the disease will start showing at this stage.

Bheda avastha

Bheda avastha is the stage of differentiation depending upon the dominance of doshas. This will predominantly depend upon the genetic constitution of the person as well as the intake of alleviators and pacifiers of that particular dosha. If there are some pacification factors in between, then the progression of disease stops at that stage only blocking presentation of clinical features. If we critically analyze and compare the pathophysiology, it can be observed that unlike modern research, the brain did not figure in Charak’s analysis of disease or their pathologic basis, nor did he emphasize the role of an exogenous or supernatural power (agantuka) factor in the causation of epilepsy. Charak has clearly mentioned heart, the abode of self and consciousness, as the origin for apasmara. In the seizure state, doshas stride upwards through dhamanis (vessels), affecting the indriyas (sense and locomotor organs) leading to erratic movements and loss of consciousness. Sushruta and Vagbhata have specifically mentioned the samajnavahishu srotasu (channels of consciousness) as the pathway of spread of doshas and as a site for the disease.

As per Ayurveda, the heart (and not the brain), is the locus or abode of the mind, consciousness and soul , and emotional factors are considered as some of the root causes for triggering epilepsy. The clinical presentation of epilepsy represents the derangement of functions of neurons of central nervous system, but the origin of this derangement shall have been predisposed much earlier due to psycho-pathological factors enlisted above. The acute onset of seizure can be precipitated due to emotional factors. The mechanism of this phenomenon and exact psycho-neuronal pathways behind this are worthy of study.

Prana vayu (buddhi-hridaya-indriya-chitta dhruk, i.e., regulation of intellect, heart, senses, mind functions), vyana vayu (seat at hridaya and regulating all types of movements), udana vayu (functions for energy and activities), sadhaka pitta (type of pitta dosha), tarpaka (type of kapha) and avalambaka kapha (type of kapha) are important to be considered as patho-physiological factors in this context.

Types of apasmara

There are four types of apasmara depending upon the predominance of dosha. The first thing of significance is that all these are sharira doshas and not manasa doshas. This implies that apasmara is predominantly a somatic disease in which psychological factors play a role in pathogenesis. The important aspect of management should be focused at the somatic level supported by psychotherapy. The role of genetic constitution is important in the study of clinical manifestations of apasmara as well as their response either to treatments involving allopathic anti-epileptic medications or to Ayurvedic treatment modalities. The diagnosis of dominance of dosha is also important in deciding the treatment modalities prescribed in cases of apasmara. The epigenetic variation of the four types of apasmara and the categorization of etio-pathological factors to lead the epigenetic modification resulting into specific type of apasmara is worthy of study.

Agantu Apasmara

Chakrapani comments that Agantuka i.e. exogenous type of apasmara is excluded unlike unmada. Thus Chakrapani rules out the possibility of external factors like deva, graha etc. to cause apasmara and emphasizes the endogenous patho-physiology of apasmara. Charak describes the possibility of exogenous factors affecting the individual to suffer from apasmara in a verse described later. The management of apasmara due to exogenous factors is similar to that described in the management of agantuja unmada.

Skanda graha and Skandapasmara

Per Ayurveda, children get afflicted by apasmara due to the effects of any of grahas (Sanskrit, means seizing) such as skandapasmara [6] [7] skanda, etc. knowledge of features of nine evil spirits which seize children is described, skanda and skandapasmara are the first two evil spirits which when affect a child, the clinical presentation is similar to that of epilepsy as narrated below.

A child seized by skanda graha has swelling of the eyes, smells like blood, has aversion to the breasts, distorted face, and eyelids or one eye having either loss of movement or more movements. The child could also be restless or irritable, have closed eyes, cry very little, hold its fists tight, and have hard bowel movement.

When the child is seized by skandapasmara, it loses and regains consciousness, is irritable, makes dancing like movements with arms and legs, eliminates stools and passes urine accompanied with sound (crying), yawns more and emits froth from the mouth. These are the features of a child seized by the “friend of skanda graham”, i.e., skandapasmara.

Similar to this, Vagbhata in Ashtanga Hridayam, has described the variants of the disease caused due to demons/evil spirits possessing the children. The cardinal signs of graha possession (or affliction) include continuous fever and crying. The general features are fear, too much yawning, movement of eyebrows, timidity, discharge of froth from mouth, upward gaze, biting of lips and teeth (grinding), wakefulness (absence of sleep), crying, moaning, aversion for the breast, change of voice, and scratching its own body or that of the mother by nails without any reason. [A.H Uttara Sthana 3/3-5][7]

In conventional medicine, epilepsy in children is described in detail. However, the etiology of some variants of epilepsy is mentioned to be idiopathic. As described in context of skanda and skandapasmara, the involvement of supernatural powers in causing apasmara is a matter of debate and falls in the purview of theology. Considering its importance and prevalence, apasmara of unknown etiology can be categorized as of the fifth type i.e. agantu apasmara. Sushruta and his commentator Dallhana support this view that any variant of the disease which occurs without any reason, acutely and without any rational pathology shall be considered as agantu. Per Charak [Cha.Sa.Chikitsa Sthana 10/53], the etiopathology, clinical features and management of this fifth type are on the lines of agantu unmada. As commented by Chakrapani, in case of agantu or bhutapasmara, the etiology of being seized by some external factors is considered primary and the involvement (anubabdha) of dosha as secondary. It is important to note here that since clinical patho-physiology cannot take place without the involvement of doshas, therefore agantu should technically be considered as one of the four doshic variants of apasmara mentioned earlier, in order to follow the sankhya niyama i.e. rules of numeral classification.

Premonitory signs of apasmara

The table 1 depicts the premonitory signs of apasmara described in the Ayurvedic texts. Each sign has a specific patho-physiology in terms of dosha and dushya behind its manifestation. The enlisted signs are the alerting signals or premonitory symptoms of apasmara before the onset of seizures. The probable system involved as per conventional medicine is also enlisted for every sign, so that it would be easier to consider the pathophysiological similarities and differences between the two medical streams.

Pūrvarūpā Translation Dosha Dushya System involved
Bhrūvyudāsa abnormal / twitching of eyebrows vata – rajas majja nervous system [NS]
Satatam akshi vaikrutam constant abnormal/ irregular movements of eyes vata – rajas majja NS
Ashabda shravanam auditory hallucinations vata –rajas manas NS, psychiatric disorder
Lala prastrava excess secretion of saliva kapha rasa NS, digestive system[DS]
Singhanaka prastrava excess nasal mucus discharge kapha rasa NS, respiratory system
Anannabhilashanam lack of appetite kapha- Pitta rasa DS, NS
Arochaka aversion to food and drinks [anorexia] Kaphapittavata rasa DS, Psychiatric disorder
Avipaka indigestion pitta rasa DS, NS
Hridaya graham heavyness of precordium/ congestion/ constriction in cardiac region kapha, vata mamsa,majja NS, musculo skeletal system,
Kukshe aatopa puffiness/ swelling in the hypogastric region vata, kapha rasa, purisha, mutra DS, urinary system
Daurbalyam debility, loss of strength kapha, vata rasa, mamsa, majja NS, musculoskeletal system
Asthibheda splitting / breaking [pain] sensation in bones vata asthi, majja skeletal system
Angamarda generalized bodyache/ twisting/churning pain in body vata mamsa, majja musculo-skeletal system, NS
Moha confused state of mind [leading to lack of knowledge] vata, kapha, Tama rasa, majja NS, psychiatric disorder
Tamas darshanam black outs / temporary loss of vision without alteration in consciousness pitta, vata rasa- rakta-majja cardio-vascular/ cerebro vascular system, NS
Murchcha syncope / a fatal condition characterized by loss of consciousness and postural tone due to vitiation of blood pitta, kapha rasa, rakta, majja cardio-vascular/ cerebro vascular system, NS
Abhikshnam Bhrama frequent vertigo/ dizziness pitta, vata, rajas rasa, rakta, rajas cardio-vascular/ cerebro vascular system, NS, psychiatric disorder
Swapne cha In dreams
Mada slight intoxication, becoming out of senses showing uncanny or abnormal behaviour vata, rajas, kapha rasa, rakta, manas Cardio-vascular/ Cerebro vascular system, NS, psychiatric disorder
Nartana dancing majja
Vyadhana needling like sensation majja
Vyathana pain majja
Vepana tremors majja
Patanadini falling etc. rasa-rakta,

majja

The abovementioned pre-clinical features are observed in the fourth stage of shatkriyakala (pathogenesis). These may be considered as aura in apasmara patients. These are important in view of prevention of apasmara progression to epileptic seizure. In conventional medicine text books, some of the above signs like auditory and visual hallucinations are referred. These signs need to be searched upon for their prevalence, categorization as per dosha dominance, involvement of dosha attributes in order to establish precise guidelines for early prevention and management of disease.

Table 2: Differentiation between types of apasmara

Characteristic feature Vataja Apasmara Pittaja Apasmara Kaphaja Apasmara
Frequency of attacks Maximum [Twelve days] More [Fifteen days] Less [One Month]
Time required to lose consciousness Minimal Less More
Time required to regain consciousness Minimal Less More
Duration of attack Minimal Less More
Clinical appearance of nails, eyes [sclera],face and skin Aruna[ downy red], Shayva[gray] , parusha [rough] Peeta [yellowish], harita [Greenish], Haridra [ turmeric yellow], Tamra [ coppery] Shukla [whitish/ pallor]
Patient experiences aura of / vision of / views of Anavasthita [unstable], Chapal [Moving/fickle] parusha [rough], Ruksha [Dry] Rupa [ looking objects] Vikrutananam [abnormal faces] [AH] Rudhirokshita [ blood], bleeding, terrifying (which is also injurious) Bhairava [frightful], Aadipta [burning] and Rushita [angry] looking objects Shukla[ white], Guru [ heavy / large in size], Snigdha [ unctuous]

looking objects

Clinical picture of abnormal movements Vishama Vinata Angulim [irregularly contracted fingers Not given specifically Anati cheshtam [ not more movements/ less movements]
Anavasthita pani Padam [ instable or continuous shaking of upper and lower limbs] Alpa Cheshtam [less abnormal movements ] [AH]
Parito Vikshipati Angam [ places body parts here and there irregularly/ involuntary movements] [AH]
Character of discharge from mouth Phenam [froth] Not mentioned specific Lalam Bhuyasi [excess saliva discharge]
Temperature of body Not specific Tapa [rise in temperature/ hyperthermia] [Su] Sheeta Anga [cold body/hypothermia] [Su]
Other Specific features Utpinditaksham [ bulging of eyes/ upside rolling of eyes] Avakujantam [epileptic cry] Patantam [falling down]
Asamna Vilapantam [incoherent speech] Aasphalayantam Bhumim [rubbing earth] Hrullas [nausea] [Su]
Trushna [excess thirst] Nidrarta [excess sleep] [Su]
Ateeva aadhmatgreevam [excess heaviness and rigidity in neck region] Sweda [excess perspiration] [Su]
Aavidhdha Shiraskam [bending of head towards one side] Murchcha [ syncope] [Su]
Kampate [ trembling/convulsions] Dhunvan Angani [shakes all body parts] [Su]
Vepamano [ tremors] Vivhala [agitated] [Su]
Dantan pradashet [grinding of teeth]
Shwasiti [increased respiration/ dyspnea]
Sakthi Sphurana [contraction like sensation in thigh region]
Viswaram [epileptic cry] [AH]
Virupam [AH]

Su: As described by Sushruta in Sushruta Samhita AH: As described in Ashtang Hridaya

The specific features of all the four types of apasmara are described in Table 2. Vata type of apasmara manifests itself with repeated seizures of short duration and increased frequency of attacks. The speed, severity and abnormality of movements are more in this case. This is due to chala (movable), laghu (light), and sukshma (minute) attributes of vata dosha. Vata is the initiator of all activities including those of the body and the mind. The regulation and coordination of the sequence of sense and locomotor organs – mind-intellect-soul for attainment of knowledge is performed by vata. Prana vata, udana vata and vyana vata are involved in the pathophysiology of apasmara. The clinical manifestation of vataja apasmara may be due to repeated, excess, hyposynchronous discharges in neurons of the central nervous system. Transient hypoxia leading to dysregulation of brain functioning, and neurological diseases similar to epilepsy syndromes can be categorized under this type of apasmara.

In pitta apasmara, the frequency, duration of paroxysms will be comparatively less than those observed in vata type. The ushna (hot) and tikshna (acrid) attributes of pitta are responsible for the pathology of paroxysms. Sadhaka pitta located at the heart and the functions responsible for accomplishment of activities are responsible for this apasmara. Tamahpravesha is a sign primarily of pitta-dominance in which metabolism or transformation at the cellular level might be an underlying pathology. Derangement of sadhaka pitta implies the decrement or depletion in psychological performance in apasmara patients. Since pitta is responsible for all metabolic activities, the derangement of metabolism at the cellular level is an important pathological factor and the enzymatic pathways might be held responsible. The types of epileptic syndromes originating due to metabolic disorders like hepatic encephalopathy can be categorized under this type. Changes in body temperature, excess thirst, and perspiration are specific differentiating features of pitta apasmara. The cerebral conditions due to derangement of metabolisms can be enlisted here. In cases of kaphaja apasmara, the sthira (stable), manda (slow), and snigdha (unctuous) attributes of kapha are responsible for delayed onset, prolonged duration as well as minimal frequency of paroxysms in apasmara. Excessive sleep and hypothermia specifically suggest kaphaja apasmara. Hypoperfusion and hypovolemic conditions leading to cerebral dysfunction can be considered as attributes of kaphaja apasmara.

Finally, the sannipatika type of apasmara presents itself with complex mixed features due to overlapping of all doshas. The prognosis is poor leading to incurability of disease. This might be a mixed presentation of neuronal, endocrinal, circulatory and metabolic pathways.

While considering the clinical pictures of a disease, the attributes of doshas responsible for variation in pathologies at somatic and psychological level should be emphasized. Important mechanisms of loss of consciousness and abnormal movements at the somatic level, and impairment of intelligence and memory at psycho-pathological levels needs to be focused. The epigenetic patterns related to particular signs and symptoms originated from doshic pathologies can be researched to reveal new treatment methods and management aspects. The genetic constitution of a person plays a significant role in making him prone to developing certain type of disorders. Therefore, as discussed above for vata apasmara can become more apparent after taking vata-aggravating diet and lifestyle in vata prakriti individuals that can get alleviated by using vata shamana (i.e., vata-pacifying) diet and lifestyle. Furthermore, if anti-epileptic drugs are used more judiciously depending upon the dosha and prakriti-specific diagnosis, then the treatment regimen can be made much more precise leading to beneficial results in patients. As discussed in the section of predisposing factors, the preventive lifestyle and dietary regimens can be designed to prevent incidence of epilepsy, reduce the dose of drugs with supportive diet and lifestyle therapy and prevent further progression of disease. Therefore, training of epileptics regarding causative and avoidable factors is of utmost importance. The epigenetic variations in epileptics due to enlisted causative agents should be studied as a part of genomic and proteomic research.

Differential diagnosis of apasmara

Other disorders such as mada (intoxication) and murchcha (syncope) also show the signs of loss of consciousness, but ones without convulsions. In unmada, there is impairment of buddhi, and it does not manifest itself with loss of consciousness. Akshepa (abnormal movements) is a vata-predominant disease characterized with convulsions, but the consciousness is intact and there is no froth discharge. This makes apasmara a distinct disease apart from other disorders.

Prognosis of apasmara

Epilepsy due to vitiation of all the three doshas and showing all clinical features of the sannipatika variant (i.e., of all the other three doshic variants) is chronic in nature and that, which has occurred in a person with excess degenerative condition and depleted dhatus, is considered incurable. In case of degenerative conditions and chronic diseases, any case of apasmara due to vitiation of even a single dosha can be considered incurable.

Bad prognostic signs of apasmara patients can often turn fatal. If one, in his wakeful state sees darkness where there is no darkness and hears all types of sound even when there is no sound, he succumbs to apasmara. If a patient, while dancing in an intoxicated state is caught by a preta (soul of a dead person) with his head facing downwards, he is sure to succumb to an attack of apasmara.

Reasons behind aggressive and dormant stages of apasmara

From the above sections, it is clear that apasmara occurs in episodes. The patient after seizure regains consciousness like waking up from sleep (suptavat pratibuddhyate). Therefore, there are two stages of disease : one is aggressive stage of doshas and the second is dormant stage of doshas. Sushruta describes that there are two forms of pathogenesis: One form follows the six stages viz. sanchaya etc.(kramopayogad) of the disease in sequence and takes considerable time to manifest disease with gradual onset. The other form manifests acutely in a short time (kshanikatwat). The first form is seen in nija (endogenous) pathologies of disease. The other form is seen in agantu (exogenous) apasmara. Sushruta gives examples of a seed in the ground that sprouts only during sharad ritu (autumn) though it rains at other times. Analogous to this example, the virulent form of the disease develops due to a dosha getting aggravated in very short time and manifesting its different symptoms due to some factors catalyzing the accelerated aggravation. It is quite clear from the detailed descriptions in this chapter, though, that all forms of apasmara are caused by dosha only. [Su.Sa.Uttara Tantra 61/1821]

The example states the fact that favorable environment for precipitating factors plays major role in disease episodes. Depending upon the defense system of the body – its natural and acquired immunity - as the background for disease and factors aggravating the dosha as offending agents, the interaction between the two defines severity, intensity and frequency of occurrence of episodes of disease as shown in chart. [ Fig.4: Manifestation of episodes ]

 
Fig.4: Manifestation of episodes

Therefore, for prevention and management of a disease, it is important either to build up the strength of defense system i.e. improving the sharira bala (physical strength) and sattva bala (mental strength), or pacify/weaken the aggravating causative factors or both.

Management of apasmara

Although the management of apasmara is described further in Chikitsa Sthana, principles of management are given in this chapter. The curable types of epilepsy should be carefully treated with strong elimination and alleviation therapies according to the vitiated dosha. Doshas present in the vessels above the heart need to be removed which require strong measures requiring medicines having higher penetrability, higher potency and highest bio-availability. With this objective, tikshna samshodhana (strong elimination) and samshamana (alleviation therapies) are employed. When extrinsic causative factors are involved (agantu apasmara), then mantras etc., will be useful.

The rationale behind advocating strong elimination therapies is the deeper location and excess vitiated state of doshas. As described in patho-physiology earlier the dosha are in dormant state in the vessels above heart. Therefore to remove these dosha, strong eliminatory therapies are needed. The strength of the prescribed medicine is decided by their higher penetrability, potency and bio-availability.

Practical application of principles

All the abovementioned principles are practically applicable. The methods for further research include the following:

  1. Supporting the clinical presentation with data of research papers on survey studies
  2. Preparing Checklist and proforma for
    1. Diagnosis of states susceptible for suffering from apasmara
    2. Diagnosis of aura stage or premonitory stage of apasmara for early identification of status epilepticus in order to train the patient and arrange necessary preventive measures
  3. Diagnosis of apasmara and specific types of apasmara based on clinical presentation

Research areas

  1. Evaluation studies of various epigenetic pathways in conjunction with the patho-physiology of apasmara
  2. Clinical correlation with modern radiological investigations like CT etc. and EEG for better clinical diagnosis of apasmara
  3. Enlisting newly introduced disease commonly observed in society into the umbrella of apasmara e.g. Alzheimer’s dementia, depression etc.
  4. Retrospective analyses of all signs and symptoms enlisted in the modern text books and formulating probable samprapti / pathophysiology (dosha-dushya sammurchchna) based on dosha dominance behind manifestation of each sign and symptom can be formulated for better understanding in Ayurvedic perspective.
  5. Assessment criteria in Ayurveda and modern science, modern investigation methods and technologies, biomarkers which are well established may be enlisted.

Research works done on apasmara at post graduate/post doctoral level:

Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India.

1. Pandya M.B. Shukla C.P. Apasmara [A Treatise on Epilepsy].1962. P.G.Thesis.

2. Sutariya Bharati.A Clinical Study on the role of Rasayana Drugs in the management of Apasmara.1988. P.G.Thesis.

3. Usha K.S. Singh Gurdip. A Clincal Study on Apasmara [Epilespy] & its management with Maha Panchagavya Ghrita. 2001.P.G.Thesis.

Faculty of Ayurveda, Banaras Hindu University, Varanasi:

4. Dwivedi KK. A Clinicalstudy of Medhya Rasayana therapy in Apasmara.1989. PG thesis.

SDM Hassan:

5. Shetty Suhas Kumar. A comparative study of Brahmi Ghrita as Shamana & Brumhana sneha in Apasmara.2001-02 6. Unni G. Effect of Kushmanda Ghrita in Apasmara.2002.

National Institute of Ayurveda, Jaipur :

7. Bhatnagar P. Antardhooma evum Bahirdhooma Tamra sindoora kalpana evum Apasmara Roga par Prabhavatmaka Adhyayana. 1992.

8. Sharma U.K. Apasmara me Samshodhana poorvaka Vacha Churna evum Smritisagar Rasa ka Chikitsatmaka Adhyayana.1999.

Ayurveda College, Mysore:

9. Yatheesha HN. To evaluate the effect of Brahmi Ghrita & Vacha choorna in the management of Apasmara- A controlled clinical study. 2003.

Shri Ayurveda College, Nagpur, Maharashtra :

10. Potbhare SM.Comparative Clinical study of role of Saraswata Churna in Apasmara.1995.

Tilak Ayurveda Mahavidyalaya, Pune, Maharashtra:

11. Kuber Asmita. Apasmara grandhokta hetu va pratyakshataha adhalanare hetu yancha taulanika Abhyasa. 2000.

Trivendrum:

12. Nagarajan C. Apasmara & its management- A critical study. 1991.

13. Manju GL. Efficacy of Kushmanada Swarasa ghrita in Apasmara.2003.

14. Murthy Niranjan.Aetio-pathogenesis and principles of management of Apasmara. 1999.

15. Indukala PR. A classical study on Majja in relation with the manifestation of Apasmara. 2003.

Reference books on Manasa Roga further reading:

1. Thakar VJ. Man ane Manas Roga

2. Singh RH. Ayurvediya Manasa Roga Vijnana.

3. Pathak Balakrishna. Ayurvediya Bhutavidya Vivechana

4. Murthy ARV. Rationale of Ayurvedic Psychiatry.

5. Murthy ARV. Mind in Ayurveda and Indian traditions.

6. Gupta SP. Psychopathology in Indian Medicine.

7. Nanal Ramesh. Mana Ani Ayurveda.

Research papers published

  • Mervyn j. Eadie. Peter f. Bladin. John libbey. A disease once sacred. A history of the medical understanding of epilepsy. Brain (2002) 125 (2): 441-442.
  • Manyam BV. Epilepsy in ancient India. Epilepsia. 1992 May-Jun;33(3):473-5.
  • Manyam BV. Dementia in Ayurveda. J Altern Complement Med. 1999 Feb;5(1):81-8.
  • Ven Murthy MR, Ranjekar PK, Ramassamy C, Deshpande M. Scientific basis for the use of Indian ayurvedic medicinal plants in the treatment of neurodegenerative disorders: Ashwagandha. Cent Nerv Syst Agents Med Chem. 2010 Sep 1;10(3):238-46.
  • Singh R.H., Murthy A.R.V. Medhya Rasayana Therapy in the management of Apasmara Vis-A-Vis Epilepsies. The Journal of Research and Education in Indian Medicine.1989.8 [1]:13-16.
  • Dwivedi K.K. & Singh R.H. A Clinical Study of Medhya Rasayana Therapy in the management of Convulsive Disorders. Journal of Research in Ayurveda and Siddha.1992:13[3-4]: 97-106.
  • Geetha L, Shetty S K, Prakash N B. A Randomized Control Trail of Brahmi Gritha In Apasmara With Reference To Generalized Tonic Clonic Seizures. 4th World Ayurveda Congress and Arogya Expo proceedings Pp. 135-136, 9-13 December 2010, Bengaluru, Karnataka, India.
  • M.H. Hakim, M.M.H. Siddiqui. A.B. Khan. Anti-epileptic activity of Ustukhudus (Lavandula stoechas) – In a case of secondary epilepsy (A Case Report). Hamdard Medicus.1991.34[ 3] 33-39.
  • Hakim M.H. Siddiqui, M.M.H. Siddiqui, A. Ismail, S.A.H. Jafri. Secondary (Symptomatic) epilepsy, an uncommon presentation. The Antiseptic.May 1991. 88[5].231-233.

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References

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